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PRINCIPL-ES 



OF- 




PATHY 



SECOND EDITION, 



BY 



Glias. n^^Y^^rA, Ph.T^. D. O 



Professor of Principles of Osteopathy in the American School of Osteo- 
pathy and Member of the Staff of Operators in the A. T. Still 
Infirmary, Kirksville, Missouri. 1898-99. 



KIRKSVILLE 

JOURNAL PRINTING CO. 

I 890. 






tr\ 



2fi753 



PREFACE. 



Since the first appearance of this work, the course of lectures of which 
the first edition was composed, has been increased in number to forty-four. 

The first edition contained discussions of theory, together with a review 
of the human body, part by part, with indications for Osteopathic examina- 
tion and treatment of the same. The second edition contains in addition, lec- 
tures upon specific diseases, with descriptions of the Osteopathic method of 
examination and treatment of the same. A limited number of cases has been 
thus treated, the idea being not to make this volume a Practice of Obteopath}^ 
but to show the method employed in diagnosis and treatment of the several 
different classes of cases that the Osteopath meets in daily practice. For ex- 
ample: acute conditions, such as typhoid fever, diarrhoea, and the like, and on 
the other hand, chronic affections, such as spinal curvatures, constipation and 
other complaints of a similar nature, have Vjeen dealt with. 

To this there have been added a few lectures upon the History of Medi- 
cine, and a brief consideration of other systems of healing, such as Faith Cure, 
Massage, Electricity, etc., in order that the student may know the principles 
of such systems, and learn to point out the independence of Osteopathy from 
them all. Chas. Hazzard. 

Kirksville, Mo., Jan 30, 1899. 



TWO COPIES fieceivcB. 



MAliH]899 




•^^ 



COPYRIGHT 1898, BY CHAS. HAZZARD, D. O. 






Principles of Osteopathy. 

LECTURE I. 

I. GKNKRAL CONSIDKRATIONS. 

lycarn to treat understandingly; imitate no operator's motions. Emerson 
says, "Imitation is suicide." Take for instance a case of erysipelas. Should 
the operator treat about the sore spots, occuring usually on one side of the face 
near the ear, and treat there alone, without giving attention to the general con- 
ditions of the patient, taking into account the affections of the kidneys, liver 
and other organs, in this trouble he would certainly not meet with success. One 
must understand the nature of the disease which he is treating. 

Make a correct diagnosis of the case. There are no two cases alike. You 
cannot take it for granted that one case which you receiv^e today is like the case 
W'hich you treated yesterday. Look over the case thoroughly , making an in- 
dividual diagnosis for it; likeness and unlikeness to other cavSes are incidental 
only. Make no diagnosis by telephone, as I knew a physician — a fellow towns- 
man of mine — did once. Remember that a young doctor's succcess often de- 
pends upon how he handles a simple case. For instance headache, which al- 
though not always simple, is frequently so. Should you be called first upon a 
case of headache and treat it successfully, granting it was a simple case, your 
future success in that town in which you may be located, may depend on that. 
I may cite here an incident told of Thoreau. It is said that, traveling on a train 
one day, he had occasion to lower the car window; soon thereafter he was ac- 
costed by a manufacturer traveling upon the same train, who said that he had 
noticed his delicate manipulation of that window and upon the strength of that 
observation offered him a position in his factory. 

Have your theories but stick to facts. Remember that you cannot always 
treat a case according to preconceived theories — that each case is peculiar to 
itself. Huxley says, "Theories do not alter facts, and the universe remains 
unchanged, even though texts crumble. 

II. GKNKRAI, CONSIDERATION OF THE SPINK. 

Origin of the Spinal Nerves (Holden): "The origin of the eight cervical 
nerves corresponds to the interval between the occiput and the 6th cervical 
spine. 

"The origin of the first six dorsal nerves corresponds to the interval be- 
tween the 6th cervical and the 4th dorsal spines. 

* 'The origin of the lower dorsal nerves corresponds to the interval between 
the 4th and nth dorsal spines. 



4 THE SPINE. 

**The origin of the five lumbar nerves corresponds to the interval between 
the nth and 12th dorsal spines. 

"The origin of the five sacral nerves corresponds to the last dorsal and first 
lumbar spines." 

Landmarks along the spine: Holden instances a median furrow caused 
by the prominence of the erectors spiuae, which extend along the spine as far 
as the interval between the 5th lumbar vertebra and the sacrum. Hollows upon 
the surface correspond generallj' to prominences of the skeleton, and vice versa. 
This is on account of the attachments by tendons to prominent skeletal points. 
Sharp friction will redden the spines of the veterbrae so that they can be count- 
ed and notice whether they are in line or not. The level of the 3rd dorsal spine 
is the level of the beginning of the spine of the scapula. 

The level of the 7th dorsal spine corresponds to the inferior angle of the 
scapula. 

The level of the 12th dorsal spine corresponds to the head of the last rib. 

The level of the 3rd intercostal space corresponds with the root of the spine 
of the scapula. 

The level of the 3d dorsal spine corresponds with the 3d intercostal space. 

The level of the 3rd intercostal space corresponds with the level of the 
right and left bronchi, the right being nearer the posterior chest wall. 

The following is a convenient method for ascertaining the position of the 
1 2th dorsal spine: Have patient fold his arms and lean forward, thus bringing 
the spines of the vetebrse out prominently; then the lower border of the trape- 
zius muscle can be traced to the 12th dorsal spine. 

The kidney is best reached by pressure below the level of the last rib at the 
outer edge of the erector spinse. 

The tip of the crest of the ilium is about the level of the spine of the 4th 
lumbar vertebra. 

The ilio-costal space extends from the lower border of the 12th rib to the 
crest of the ilium, varying in width from the width of a finger to that of a hand. 
So says Holden. I would caution you, however, in the former case to ascer- 
tain carefully whether or not there be a dropping of the ribs and alteration of 
the chest in its antero-posterior diameter. Such a condition, a narrow ilio-costal 
space, is usually accompanied b}' neurasthenia and kindred affections in the 
patient. 

In the depression below the occiput are found the edge of the trapezius 
muscle and the upper end of the ligamentum nuchse. 

The 2nd cervical spine is forked and rather prominent. The 3d, 4th and 
5th cervical spines are not usually made out, as they recede anteriorly from the 
surface. The 6th and 7th (prominens) are prominent. The spines of the dor- 
sal vertebrae correspond with the heads of the ribs next above, e. g,, the 4th 
dorsal spine with the head of the 3rd rib. But the nth and 12th dorsal spines 
correspond with the heads of those ribs. 



EXAMINATION OF THE SPINE. 5 

III. II.LUSTRATIONS UPON THE SPINE. 

In the location of the atlas, it is felt only by making out its transverse 
processes, which are readily felt on each side between the mastoid process and 
the angle of the inferior maxillary bone; the normal position being about mid- 
way between these points on either side. Should there be a deviation from the 
normal, either to one side or the other, anteriorly or posteriorly, or a twist in 
either direction, it is readily made out by the trained touch. 

Peculiar vertebrae are found along the spine, viz. : the 2nd, 6th and yth 
cervical, 12th dorsal and 5th lumbar. The 2nd cervical is noticeable because 
of being slightly prominent and bifid. The 6th and yth cervical because of 
slight prominence. The 12th dorsal because it often marks what the Osteo- 
path calls a "break," a separation of the spines of the vertebrae occurring be- 
tween the 12 th dorsal and ist lumbar. This is a point of importance. The 
same is the case. with the 5th lumbar, there often being a break between its 
spine and the superior crest of the sacrum. 

The ligamentum nuchse is of great importance to the Osteopath. You will 
remember that it extends from the occipital protuberance to the yth cervical 
spine. You must learn to recognize it by touch. Frequently it will contract 
and is the sole means of relieving headache when stretched. 

HOW TO EXAMINE A SPINE. 

In the first place, notice if at any point along the spinal column the spine 
of any vertebra is deviated laterally. In such a case there is usually a sore 
spot in the muscles upon the side of the spine toward which it is deviated. In 
the neck we do not depend upon the prominences of the spines behind, to diag- 
nose a slip in the vertebrae, but by turning the head to one side, thus bringing 
into prominence the transverse processes of the vertebrae, we may ascertain 
whether or not one is prominent anteriorly or posteriorly; in such a case a sore 
spot usually is found at the end of the transverse process of the vertebra. 
Spines may be separated at any point along the column; you may find the 
spines abnormally far apart. We occasionally find what is designated a smooth 
spinal column, by which I mean that a spinal column may have its vertebrae 
so protected by the thickening of the ligaments or other structures as to obvi- 
ate the ordinary feeling one experiences in running the hand down the spine. 
For such a condition I have somewhat arbitrarily adopted the term, "a smooth 
spinal column." The natural curves of the spine may be changed, as will 
readily be observed by you in practice. I do not speak here of spinal curva- 
tures, not at all; but frequently a slight, or it may be a marked, deviation from 
the natural curve described by the normal spinal column, will be noticed. 
Hence, if there is a break, ligaments often cause lesions in that they may, by 
the displacement of the bouv parts to which they are attached, be dragged 
across some important structure, such as a nerve or blood vessel, thus compres- 
sing it and abridging its function. 

These points upon how to examine a spine will be continued in further 
lectures, and their significance to the Osteopath be fully considered at those 
times. 



LECTURE n. 

I. CENTERS OF THK SYMPATHETIC: —These centers are of vast import- 
ance to the Osteopath. Reasoning according to centers is frequently with 
him going from effect back to cause, and of course from periphery back to cen- 
ter. It instances one of his modes of thought; and to acquire this habit of mind 
and thought is frequently the basis of our professional success. There is a 
given definite center for the activities of a given point or organ. For instance, 
there is a center for which we work to affect the kidney; or, we maj^ say, there 
is a given definite center for each physiological process. As for instance, there 
is a center upon which we work to affect the general circulation. In the absence 
of a discoverable lesion, which frequently occurs, the Osteopath's work must be 
largely on the centers, sometimes entirely so. Even when the lesion has been 
found and attended to, he must give much attention to the particular center 
governing the part affected. Remember, it is going back to first principles. 
I would beg you to remember that the following points have been gathered from 
various .sources; from the experience of operators, from lectures heard from oth- 
ers, from books, from conversations, from my own personal experience, and 
that I cannot in every case give you the authority for the center designated. I 
speak of the centers more in an Osteopathic than in a purely physiological sense, 
meaning that point along the spine which has designated itself as a center in 
response to the work upon it; results justify such statements. In other cases, 
of course, these so-called centers are the physiological centers indicated by the 
authorities. 

Centers of the Sympathetic. (For the following centers I am especially in- 
debted to Drs. Alice Patterson and C P. McConnell.): 

Third cervical vertebra, middle of neck. Above manipulate upward; below 
manipulate downward. 

Third, fourth and fifth cervical, origin of the phrenic — hiccoughs. 

Third, fourth, fifth and sixth, vaso motors. The superior cervical gang- 
lion is connected with the first to fourth cervical nerves. This ganglion lying 
opposite the second and third cervical vertebrae. The middle cervical ganglion 
connected with the fifth and sixth cervical nerves; this ganglion lying opposite, 
the sixth and seventh cervical vertebrae. 

The point between the first and second dorsal vertebrae, the center to the 
lungs. 

First rib for heart flutter. 

Between second and third dorsal, ciliary center, and recti of eye ball. 

Between fourth and fifth dorsal on right side for the stomach center; on the 
left pneumogastric for the pyloric orifice. 

Fifth and sixth dorsal, vaso motors to the arm. 

Fifth, sixth, seventh and eighth dorsal, great splanchnics* 

Eighth dorsal, center for chills. 

Between eighth and ninth dorsal, center for liver. 



SPINAL CSNITERS. '7 

Ninth, tenth and eleventh dorsal, small splanchnics. 

Twelfth, smallest splanchnic. 

From a point between the seventh cervical and first dorsal to a point be- 
tween the eighth and ninth dorsal, the center for the anterior dorsal branches, 
which convey dorsal branches to pulmonary center. The posterior pulmonary 
plexus connects with the second, third and fourth ganglia of the sympathetic. 
The anterior pulmonary plexus from the pneumogastric and sympathetics. 
Vaso motors to the lungs have been found in the dog from the second to the 
seventh dorsal. This corresponds to the centers upon which we work in man 
to reach the lungs. 

Second lumbar vertebrae, center for parturition, micturition, defecation. 

Third lumbar, coeliac axis. 

Point between fourth and fifth lumbar vertebrae, defecation. 

Fifth lumbar, center for hypogastric plexus. 

From a point between the second and third sacral to a point between the 
fourth and fifth sacral, center for the neck of the bladder. 

Fourth sacral, center to relax vagina. 

Fifth sacral, sphincter ani (the latter two are spinal branches.) 

The term "cervical brain" has been applied by Dr. Still to the region lying 
between the first cervical vertebra and the fourth dorsal vertebra. The term 
''abdominal brain," has been applied by him to the region lying between the 
first dorsal and third lumbar vertebrae. Pelvic brain, to that region lying be- 
tween the tenth dorsal and fifth lumbar vertebrae. 

Other centers of the sympathetic are as follows: 

Sensation, atlas to fourth dorsal. 

Motion, fourth dorsal to sixth dorsal. 

Nutrition, sixth dorsal to coccyx. 

These three centers are spoken of by Dr. Still, not fully understood b}' me 
and are still food for thought. 

Centers in the medulla as follows: Cough, sneeze, vomit, respiration, sal- 
ivation, phonation and deglutition, renal center, center for spasms. 

Vaso motor centers: Medulla, second to sixth dorsal, fifth lumbar. 

(I remember once when sent to attend a case of Dr. Hildreth's, his words 
to me were, "Reduce the fever by desensitizing in the superior cervical gang- 
lion, the middle donsal and lower lumbar.") 

Cilio-spinal center, fifth cervical to the second or fourth dorsal. • 

To dilate the iris and contract the pupil, from fifth cervical by the superior 
cervical ganglion. 

Heart center, in the corpora striata; first rib; first, second, third, fourth 
and fifth dorsal vertebrae. 

Cervix uteri, ninth dorsal. 

Blood supply to ovaries, eleventh dorsal. 

Uterus, second lumbar, second and third cervical vertebra, also from hypo- 
gastric plexus by the lower dorsal and four upper lumbar nerves and through 
the splanchnics. 



8 EXAMINATION OF THE SPINE. 

Vaso motois of the head: The eye, ear, salivary glands, tongue, brain, 
etc., are all reached at the superior cervical ganglion. Here also a general vaso- 
motor effect to the body is claimed. Vaso constrictors for the head are said to 
exist at the fifth and sixth dorsal vertebrae. Stimulation of the superior cervi- 
cal ganglion has a vaso constrictor effect upon the vessels of the retina, proba- 
bly through its ascending branch and its connection with the fifth nerve. 

The lungs, second to seventh dorsal vertebrae. 

Jejunum, first to fifth dorsal vertebrae. 

Small intestine, above first lumbar. 

Large intestine, first to fourth lumbar. 

lyiver, from the splanchnics, vagi, and inferior cervical ganglion. 

Kidneys, at the sixth dorsal, second lumbar, renal splanchnics and superior 
cervical ganglion. 

Spleen: splanchnics on the left side, eighth to twelfth dorsal. 

Lower limbs, second dorsal down. 

Circulation, superficial fascia (the second dorsal for the upper part of the 
body, the fifth lumbar for the lower part.) 

Valves of the heart, second to fourth dorsal. 

Rhythm of the heart, third and fourth cervical. 

The genito-spinal center and lower hypogastric plexus and plexus to intes- 
tinal canal, bladder and vasa deferentia, at the fourth and fifth lumbar. 

Bowels, peristalsis, ninth, tenth and especially the eleventh dorsal. 

Larynx, first, second and third cervical. 

III. How TO Examine a Spine. — (Continued.) — Look for the lesion al- 
ways. It may be high above or much below the usual center. For instance, 
we may work as high as the lower dorsal for sciatica, its center being in the 
sacral plexus. This lesion may be in the nature of a strain, congested muscle, 
a dragging of ligaments, a tightening of the ligaments, thus drawing the verte- 
brae together. It may be in the nature of a sprain or break. It may even be 
absent. But remember that your duty is not done until j^ou have thoroughly 
looked for the lesion. A congestion of the spinal muscles is often noticed on 
examination; it may be of the superficial muscles or of the deep muscles; it may 
be primary or secondary. By primary, I mean a congestion to the muscles set 
up by some direct effect upon them, e. g., the effects of a draft or a blow. This 
congestion involves the peripheral termination of the spinal nerves, acting 
through them and through their sympathetic connections to affect some inter- 
nal viscus. By secondary, I mean the reverse, for example, the stomach may 
be affected, and the affects may be transmitted over the solar plexus back along 
the splanchnics thence to the spinal nerves with which the splanchnics are con- 
nected, thence back over the peripheral terminations of these nerves to the skin 
and muscles of the back. You may, in your examination of the spine, find 
that it is frequently rigid, not pliant; on the other hand, you may find that it 
is quite relaxed; abnormally mobile. 



CONSIDERATION OF THE SYMPATHETIC. 9 

LECTURE III. 

I. Further Consideration of the Sympathetic System: — I have 
already spoken of the importance that we as Osteopaths attach to centers, espec- 
ially to those centers which I have given you along the spine. The theory of 
our work upon them and their significance in connection with disease we shall 
take up later. I may in passing, however, say that they are one of the most 
important things by which the Osteopath has to work. The same is true of 
the sympathetic system in general. The general anatomy of the sympathetic 
system is doubtless already known to you, but there are points which I wish to 
recall to your attention and cite you their significance from our standpoint. 

Points FROM Quain: — The sympathetics are connected with the spinal 
nerves by white and gray rami communicantes. The white are medullated and 
pass from the spinal nerves to the sympathetic ganglia. Some white fibres pass 
from the ganglion to the efferent ramus. Some end in Ihe ganglia; they may 
ascend or descend in the sympathetic cord to higher or lower ganglia, thus con- 
necting with several, and being in this manner widely distributed to the sym- 
pathetics. The gray rami communicantes are non-medullated, or pale. They 
pass from the sympathetic ganglia back to the spinal nerves, the reverse of the 
white. They arise from cells in the sympathetic ganglia. They may, rarely 
however, run in the sympathetic cord to another ganglion, and then emerge to 
take their course to the spinal nerves. They enter the anterior primary divis- 
ion of the spinal nerves, divide to send some fibres centrally toward the cord, 
some peripherally through the spinal nerves to the general system. Those 
gray fibres of the sympathetic which pass centrally join in part a recurrent 
branch of the spinal nerve and with it run to supply the vertebrae, the dura 
mater, the ligaments and blood vessels of the spinal canal. Other filaments 
pass over the bodies of the vertebra and supply the intercostal and lumbar ar- 
teries and viens, ligaments and bones. Thus, the central distribution of the 
sympathetic nerve is of great importance to the Osteopath in his work of build- 
ing up a weak or defective spine, and helps, in part at least, to explain the 
wonderful results he obtains in that department of his work. Those sympa- 
thetic fibres which pass distally in the anterior and posterior primary divisions 
of the spinal nerves supply the blood vessels of the body walls and muscles with 
vaso-motor fibres, and the sweat glands of the skin with secretory fibres, and 
the hairs with pilo-motor fibres. 

Here again the sympathetic system becomes significant from the Osteo- 
pathic point of view, and aids in explaining the reasons for the immediate re- 
sults attained in keeping the skin, the so-called lung, and superficial fascia in 
good working order. It is important in cases of blood and skin diseases and in 
fevers. The centers of the superficial fascia, you will remember are the 2d 
dorsal and the 5th lumbar. The Old Doctor, who in the past few months has 
been making special studies upon this subject, attaches great importance to 
superficial fascia. Of equal, or perhaps greater importance, finally are the vis- 



ro SYMPATHE^TIC SYSTKM. LANDMARKS.} 

ceral distributions of the sympathetic nerves, there being efferent branches run- 
ning forward from the sympathetic ganglion to the great pre-vertebral plexuses, 
the cardiac, solar, hypogastric and pelvic plexuses, so-called primary plexuses 
and their secondary plexuses, e. g., the phrenic, renal, spermatic, coelic, super- 
ior and inferior mesentric, aortic, hemorrhoidal, vesical, etc. Their importance 
to the Osteopath lies in the fact that through them he may regulate the actions 
of the internal viscera to a wonderful degree. Thus we stumble onto the para- 
dox that a man's internal, organic life may come under the control of anotker 
to a greater or less extent. 

Some gray fibres pass from the ganglia out over the efferent rami. I have 
placed here on the board a diagram from Quain in which you note illustrated 
the points which I have brought out concerning the gray and white rami com- 
municantes and their connections with the anterior and posterior divisions of 
the spinal nerves, their course toward the cord and also the efferent rami run- 
ning outward to the great prevertebral plexuses. The medullated fibres, that 
is, those of the white rami, may be, ist, sensory, running from the poster- 
ior root of the spinal nerve; 2nd, vaso and viscero-constrictors, from the 9th, loth 
and nth cranial nerves ending in the sympathetic ganglion, whence their action 
is carried out through pale fibres rising from cells in the ganglia. These fibres 
thus have become demeduUated by passing through the sympathetic ganglia; 
3rd, vaso dilators from the anterior and posterior spinal roots, and from the 9th, 
. I oth and nth cranial nerves, pass through the sympathetic ganglia, do not 
connect with any nerve cells therein, and reach the organ they supply as med- 
ullated nerves. 

II. Landmarks. A tabular plan of the parts opposite the spines of the 
vertebrae. After Holden. Opposite 7th cervical spine, apex of lung, higher 
in females. 

Opposite 3rd dorsal, aorta reaches spine, apex of lower lobe of lung, angle 
of bifurcation of trachea. 

Opposite 4th dorsal spine, aortic ends; upper level of heart. 

" " 8 th ' * " lower level of heart ; central tendon of diaphragm. 
'* " 9th " " oesophagus and vena cava perforate diaphragm; 
upper edge of spleen. 

Opposite loth dorsal spine, lower edge of lung; liver comes to the surface 
posteriorly; cardiac orifice of stomach. 

Opposite nth dorsal spine, lower edge of spleen; supra -renal capsule. 
Opposite I2th dorsal spine, lowest part of pleura; aorta perforates diaphragm; 
pylorus. 

Opposite I St lumbar spine, renal artery; pelvis of kidney. 

" " 2nd ** " termination of spinal cord; pancreas; duodenum 
just below; receptaculum chyli. 

Opposite 3rd lumbar spine, umbilicus; lower border of kidney. 
" " 4th " " division of aorta; highest part of ilium. 



EXAMINATION OF THE SPINE. 1 1 

Apex of lung is most liable to disease; may be examined by percussion at 
external end of clavicle. 

Angle of bifurcation of trachea is in some cases opposite the 4th dorsal 
spine. This angle corresponds in front with the junction of the first and second 
parts of the sternum. As to the kidney, its upper border may be as high as the 
level of the space between the nth and 12th dorsal spines. Its lower border 
may extend as low as the 3rd lumbar spine. 

III. How^ To EXAMINE A Spine. — (Continued.) — I spoke in a previous 
lecture of variations of curves of the spine from the normal. A few more words 
concerning this. There may come to your notice in your examination of a 
spine a flattening between the shoulders; on the contrary, the tendency there 
may be posterior decidedly. The same condition may prevail immediately be- 
low the shoulders about the middle of the back. You may have a posterior 
flattening of the lumbar region, which naturally, as you know, is curved an- 
teriorly. But, on the other hand, you may have too pronounced a tendency 
anteriorly in this region. Again, you may have all of the normal curves of the 
spine lessened, leaving what we describe as a straight spine. You will readily 
see that in such a condition the whole equilibrium of the body is more or less 
disturbed. You may find the sacrum itself too prominent posteriorly, or too 
flat, thus increasing or diminishing the antero-posterior diameter of the pelvis. 
Finally, you may find that the coccyx has been bent to one side, in which case 
it may be the cause of piles; it may be bent forward, as frequently you will find, 
from horseback riding, etc. In such a case it may become a mechanical imped- 
iment to the passage of fecal matter, thus mechanically causing constipation. 
Remember, please, that in calling your attention to these points in how to ex- 
amine a spine, I have left aside the subject of their significance. That subject 
will be fully considered in later lectures. 



LECTURE IV. 

HOW TO EXAMINE A SPINE (CONCLUDED.) 

There are a few more points regarding the abnormal curves of the spine, 
which I think will be useful to you — flattening between the shoulders or pos- 
terior tendency there — the posterior tendency that we frequently meet with 
along the lumbar region or flattening there. Then the different positions that 
we find upon examination that the coccyx has assumed, and the dift'erent posi- 
tions in which we find the sacrum itself. Also I may mention the fact that 
there may be considerable variation in the curves of the spine, so that you maj^ 
have quite a straight spine by the time you have looked over all the points. 
Hence the natural equilibrium may be destroyed in that way. 

There is one other point which you will probably find, and that is that a 
vertebra may not only be slipped from side to side, but by following the curve 
along the spine we may at any point come to a vertebra extending backward — 
not only one or two, but several may be displaced backward; or you may find 



12 SIGNIFICANCE IN SPINAI. EXAMINATION. 

a single one displaced anteriorly, I was treating a case not long ago in which 
one of the dorsal vertebrae was pushed anteriorly, and it had an effect upon the 
kidneys. It generally affects the center near where it occurs. 

Hilton says that frequently he has found that a pressure of the head 
straight downward on the spine, and then rotation from side to side will cause 
a sensation of pain in the cervical region, and will be evidence of disease there, 
when one has not been able to find it by other diagnosis. He has found that 
the general symptoms justified his locating the disease in the upper cervical 
vertebrae. 

There is another point that is cot of very much importance to you, but you 
should understand it, because 3'our patients will notice it probably, and are apt 
to ask you to explain why it should occur. That is, as you work along the 
spine you may hear certain noises, somewhat like popping. You will find 
them all along the spine, sometimes distinctly on one side, sometimes distinctly 
on the other. Also when you are workidg in the neck, moving it from side to 
side or in any way, you may get a click. Or the patient may hear it when he 
is turning his head from side to side. Now the reason as to why 3'OU hear 
these noises along the spine is explained differently in the different regions. In 
the dorsal region there are three things that may move. The whole vertebra 
maybe moved; of course there is inter-vertebral motion, but we do not get 
many of these noises from that cause, on account of the way they are bound 
together, being connected by inter-vertebral discs, with no synoviol membrane. 
The second place in which you may get motion is between the head of the rib 
and its articulation with the bodies of the vertebrae and the inter- vertebral 
substances. Then in the third place, you have motion between the tubercles 
where they articulate with the transverse processes of the next verte- 
bra below. In the neck the only place you are liable to get any click is between 
the articular processes of the vertebrae. These noises in the spine are not of 
much significance, but you will meet them and of course would like to under- 
stand them for the patient's sake, because if they find you do not understand 
these things, you may lose a valuable patient. 

II. OSTEOPATHIC SIGNIFICA.XCE OF POINTS OBSERVED IN EXAMINATION OF 

THE SPINE. 

After understanding fully how to examine the spine, your next question 
naturally is, "When I have found these things along the spine, what is their 
significance? If we do not know what they mean they are useless to us. When 
once you know^ the results of certain lesions it does not take you long to find 
the lesion. I have therefore for the present dropped the subject of the sympa- 
thetic nerve, and have decided to devote one or two lectures to the general con- 
sideration of the osteopathic significance of the points which we find in our 
examination of the spine. Remember, please, this cannot be given to you in 
full by lectures, and that you will recognize the full significance only in your 
practice. I can make it plainer later when we take up particular cases. What 
I want to do is to show you the significance of certain points, and to get you 



METHODS OF OSTEOPATHIC REASONING 1 3 

into the habit of osteopathic reasoning — to show you how we look at these 
thinga, and the process of thought followed. 

The first point, then, is as follows: In general, a lesion along the spine, 
whatever its character, affects the center at which it occurs, and thus may 
affect cerebro- spinal life or sympathetic life, either or both. The former, if it 
is more superficial, in general, and the latter if it is deeper in general. As to 
the character of the lesion, it may be of any form found in the examination of 
the spine. As to locality, it may be either superficial or deep. You may find 
along between the shoulders a flattening, which may extend as low as the 8th 
dorsal, and interfere with the centers of the stomach. If it be serious in char- 
acter it will extend deep enough to affect the sympathetics, and thus organic 
life, and you will probably have stomach trouble. If it is not deep enough to 
affect the sympathetic life, it may affect the cerebro-spinal life and you will 
have a lame back; or if it is in the region of the 6th or 7th dorsal, pains may 
run around the ribs and meet over the pit of the stomach at the abdomen. 
The character of the injury may be such that it affects deeper structures, or it 
may have a more superficial effect. 

The next point in osteopathic reasoning is the consideration of the amount 
or intensity of life displayed in any given condition. This is an important 
point, and perhaps not clearly expressed, but I will try to make it plain to you. 
You may have a rigid spine, or you may have a relaxed spine. Now, in gen- 
eral, the process of reasoning which the osteopath uses is about as follows^ 
The fact that the spine is relaxed shows a lack of nerve force, a lack of life 
there. On the other hand, if there is great tension along the spine, the spine 
is closely bound down and held together by the ligaments, so that you have a 
rigid spine with little motion, the reasoning would be, to some extent at least,, 
that there had been an injury to the spine or a strain that had resulted in di- 
recting too much nerve force to that part of the body for a shorter or longer 
period of time, which resulted in throwing too much food supply there, causing 
a thickening of the ligaments binding the vertebrae together. Of course col- 
laterlly, when too much life and vigor was thrown to that part it was robbing 
some other point. 

Take several illustrations to make this clear: You may have a tension in 
the spinal muscles. It may seem queer to you, or to your patients, for you to 
tell them that a muscle is contracted, congested or drawn, and has remained 
that way. It is hard to believe, but such is the fact. What does such a con- 
dition argue to your mind? Simply that there is too great an amount of nerve 
force there, which, reacting upon the muscles, causes them to contract. In 
that case your nervous force is in the nature of a violent stimulation to those 
terminal sensory nerves. On the other hand, it may be secondary from the 
condition of an internal viscus. There may be some visceral disease, say 
stomach trouble, which would be reflected from the solar plexus out along the 
splanchnics to the spinal nerves, and through the spinal nerves back to their 
destination. There may be a misdirection of nerve force or life, which life is 



14 SIGNIFICANCE IN SPINAL EXAMINATION. 

sent to the spinal muscles, and 3^ou have too great a supply of nerve force 
along the spine. We reason according to the amount of nerve force or life sent 
to these points. Again, when you make a digital examination of the rectum, 
you ma}' find that there is some irritation which acts in the nature of a stimu- 
lation to the nerve force which supplies that rectal sphincter, and is causing it 
to contract. On the other hand, you will find in some examinations that there 
is no force put forth whatever, the sphincter is relaxed, and in such cases it is 
very likely that the patient is suffering from incontinence of fecal matter. In 
the one case there is too much nerve life, in the other too little. This may also 
result from visceral troubles. In a case of diarrhoea the Osteopath first exam- 
ines to find some lesion along the spine at the gth, loth, or nth dorsal, caus- 
ing too much nerve force to be directed from the sympathetic sj^stem to the 
intestine so that there is too rapid peristalsis and also too great a secretion of 
-watery matter. There is too much nerve life there, or there could not be too 
much motion. On the other hand, in constipation, either something has hap- 
pened to deaden the nerve force or to disseminate nerve force to other parts of 
the body so that 3'ou have too little left. You have not enough energy to pass 
the fecal matter along its course, and the result is a case of constipation. This 
is not a full explanation of all these cases, but I simply use them as illustra- 
tions. You will find this a valuable point in Osteopathic reasoning. In the 
former case the Osteopath adopts such measures as will disseminate the nerve 
force and equalize it throughout the body. In the latter case he directs his 
attention to a rational means of renewing the nerve force which is lacking at 
the point affected. 

When you find upon examination that the spines are separated, what is 
your conclusion? Simply that some lesion has caused a relaxation. There is 
too little life, and hence a separation. This may impinge upon the nerve cen- 
ters and there will be trouble according to the center over which the lesion has 
occurred. In a case of a "smooth spine," where every vertebra seems to be 
drawn down close to its fellow, there seems to have resulted a contraction of 
the ligaments connecting them, affecting almost all of the centers along the 
spine to a greater or less degree; there may result neurasthenia, a general lack 
of nutrition, general eye troubles, nervous troubles, circulatory affections. 

A spine twisted leads us to look at the center which is affected. This 
brings us to the tension on the ligaments which I have mentioned a time or 
two before. When we have a case in which there is a twist of the vertebra, 
we reason from the position of parts as to what ligaments are affected. Sup- 
pose, for instance, that a vertebra is twisted so that a spine instead of being 
exactly in line, is turned toward the right, then what is the condition of the 
ligaments? The anterior and posterior ligaments along the bodies of the ver- 
tebra will be obliquely upon a tension, the supra-spinous and inter spinous 
ligaments will also be upon a strain, the ligamentum subflavium on the left 
side will be tightened and that on the right side tightened also; the inter- 
transverse ligaments on each side will be tight, and extend one forward and 



SIGNIBICANCK IN SPINAIy BXAMINA^ION. 1 5. 

the other backward. This is the method of reasoning you should adopt, and 
you should reason from the symptoms as to what nerves are affected. You 
will find that the ligaments may draw across nerves in such a way as to affect- 
nervous life, either spinal alone or sympathetic through the spinal. 

I mentioned along the spine certain peculiar vertebrae. In regard to the 
second cervical vertebra, if you are a young Osteopath and examining your 
first patient, you will be sure to find something wrong with that vertebra. 
Please bear in mind that it is not like the others, but has a prominent forked 
spine. You may make the same mistake with the 7th cervical. You should 
acquaint yourselves with these natural conditions, so that you may judge cor- 
rectly as to any change from the normal condition. Then bear in mind also 
that the 12th dorsal and the 5th lumbar are very apt to be points of mis- 
chief, and a separation is very likely to take place at those points. Between 
the 5th lumbar and the sacrum is a point which is frequently affected and 
which makes a great deal of trouble. The 5th lumbar may be anterior or it 
may be posterior, and in such a case it depends upon your other symptoms as 
to how you will diagnose your case. This may cause trouble with the viscera 
supplied by the sympathetic nerve, there may uterine trouble, trouble with the 
generative organs of either sex, paresis, paralysis, or sciatica. 

In these variations from the normal curves of the spine in general the sig- 
nification to the Osteopath is as follows: It there is a flattening or posterior 
tendency between the shoulders, you will generally find that the patient has 
heart or lung trouble. You will expect to find some leision there affecting those 
organs, which acts directly by impinging upon the nerves or by changing the 
position of the ribs. There may be a change in the first or second rib, causing 
heart trouble; of the 7th rib, causing asthma. You may have heart or lung 
trouble there, or if it is as low as the 8th dorsal you may have stomach trouble, 
or there may be renal trouble caused by a leison as high as the 2nd dorsal, or 
sciatica as high as the 2nd dorsal. You must reason according to the centers 
affected. If there is a change from the natural curve in the region of the 
splanchnics from below the shoulders to the first lumbar, then look for such 
troubles as intestinal affections, renal troubles, This same reasoning applies 
in general to the sacrum and coccyx. The coccyx may cause either mechan- 
ical troubles, such as piles and constipation, or sympathetic trouble and affect 
the internal viscera in that way. 

The Osteopath finds the atlas of great importance to him in his work, for the 
reason that it may impinge upon certain nerves, and may affect spinal centers; 
or it may act in such a way as to deprive the brain of its suppl}^ of nutrition, 
and thus lead to results which are very significant to the Osteopath. It may act 
in such a way as to shut off the blood supply to the brain, and it may affect 
every center in the brain. Hence, you may commonly find that j^our patient 
has been unable to speak for a long time, or has been unable to hear plainly, or 
he may have become insane. It may also impinge so much that it presses on 
the cord and robs it of its nutrition, so that there may follow various spinal 



.J 6 SIGNIFICANCK IN SPINAI, EXAMINATION. 

troubles. It may press upon it on one side, causing hemiphlegia, the patient 
liaving no use of one half of his body, the legs and arms being small in the 
case of a child where the development has been impaired. This is the Osteo- 
pathic way of looking at a case when you find that the first cervical has been 
slipped. I had a case of this kind not long ago. The result was that the child 
could not speak; it could say "Mamma," but everything else that it said was 
just a peculiar sound; it could not articulate except that single word. In ad- 
dition to that its left side was paralyzed, or there was a paresis there; the child 
limped, the leg was short and the arm was drawn up. The whole trouble there 
was really at the first cervical vertebra, which was slipped, affecting the spinal 
cord and the brain, either through its blood supply or directly by impinge- 
ment. 

What is the significance of the noises that we find along the spine? Usu- 
ally nothing whatever. You may find noises all along the spine in a man who 
is quite healthy. But on the other hand, it may have considerable significance 
and these the Osteopath should always take into consideration. As I have ex- 
plained, either the heads or tubercles of the ribs may be slipped, or the position 
of the vertebra may be changed, or the articular processes may cause a great 
deal of trouble in the neck. The Osteopath in thinking of these things thinks 
of the normal anatomy of the part. He says, here is a point which may be sub- 
jected to a strain or twist, it can be extended or shortened to some extent, so 
that these are moveable points; and being points at which a strain may occur, 
are points which are liable to disease. You will find this of great significance 
in the etiology of spinal curvature. Along this line I simplj^ want to quote 
from Halliburton. He says "Diseases of the spine may begin in the vertebrae 
or in the inter-vertebral substances; I think on the whole, in the intervertebral 
substances where it is joined to the vertebrae." His editor. Dr. Jacobin, says 
that his view is supported by the fa^-t that the junction of a more with a less 
elastic body is the weakest spot and therefore receives the full effect of the 
strain. He instances the case of an atheromatous artery, the weakest portion 
is where the diseased wall joins with the more elastic substance of the healthy 
wall, and it is at that point where the real strain comes and where an aneurism 
is likely to occur. Hence, as explained, here arises for the Osteopath the 
significance of a distorted vertebra, causing a slight irritation of the parts, 
throwing too much blood and nerve force and life there and setting up some 
irritation, causing a thickening of the ligaments and perhaps a permanent injury 
to certain parts, especially the nerves. 

The Osteopath realizes that the ill effects of injuries along the spine are 
not dependent upon their great extent. That is to say, you may have a very 
bad curvature of the spine which is congenital, or there may be a ver}^ bad cur- 
vature of the spine which had come on through years, without very serious 
trouble following. In such cases where the curvature has covered a very long 
period of time, or where a child has been born so, the parts become adapted 
to the variation from the normal, and such persons may go through life with 



SIGNIFICANT POINTS IN DIAGNOSIS. 1 7 

good organic life, I have seen some cases of dwarfs or hunch-backs, who had 
very good health; and reasoning from the Osteopathic standpoint, we some- 
times wonder why it is in such pronounced curvatures of the spine, the person 
does not have stomach trouble, bowel trouble, why the kidneys are not affected 
and so on. On the other hand, you may have a man with a vSound back, but 
who has a little twist of one vertebra, which may make him a great deal of 
trouble. So the Osteopath reasons not from the great extent of the departure 
from normal, but from the center affected and from antecedent conditions. Hil- 
ton says that almost all diseases of the spine are the result of some slight strain 
or some slight accident, and that is what the Osteopath finds every week of his 
practice. A man will come into your ofiice in trouble; you will find a spinal 
lesion. He knows he never fell, a horse never kicked him or anything of that 
kind, but in about three weeks he will come and tell you that he went home 
and talked with his wife, and she reminded him of that time he fell down 
the court-house steps, or something of that kind. He has had some accident 
w^hich he had overlooked, but which has caused some slight lesion of the spine, 
taking time to develop, but which has at last caused considerable trouble. 
Hilton also instances a very serious case in which the lesion of the spine was 
not discovered at all; it was only after the patient had been fourteen years a 
paralytic and died that post mortem revealed the fact that the 5th, 6th and 7th 
cervical vertebrae had been ankylosed. The fall which caused it was a fall of 
forty feet upon his back and neck; upon examination of the patient he was un- 
able to find any lesion in these parts at the time. So the lesion may not be 
discoverable. . 

Once more, Hilton says that he believes many cases of spinal diseases are 
due to a slight injury which has been overlooked, or to exercise persisted in 
after fatigue. A man falls down, says he has not been hurt, gets up and rubs 
himself to restore circulation, and thinks nothing more of it; but as Hilton 
says, very slight injury may cause very serious results, and the Osteopath has 
to take all these things into consideration, and reason accordingly. 



LECTURE V. 

At the last lecture I called your attention to how to examine the spine, 
concluding that subject. I also took up the Osteopathic significance of certain 
special points which we had before noticed in our examination of the spine. 
In general, a leision affects a center over which it occurs. The Osteopath rea- 
sons from the amount of intensit}' of nerve forse display at any point. Spines 
may be separate or approximated. I called your attention to the special verte- 
brae, the 2ud and ytli cervical, and leison at the 12th dorsal and 5tli lumbar, 
and instanced the results of such lesions. I called your attention to the dis- 
placement of the atlas, stating that it was of great significance to the Osteopath, 
as it may shut off blood supply to the brain and may impinge upon the cord, 



1 8 SIGNIFIGAN.C^ OF POINTS IN DIAGNOSIS. 

causing serious troubles. I also called your attention, finally, to the fact that 
the Osteopath does not measure the injury by its vast extent, instancing the 
case of the hunch-back with good organic health, versus the case of a man.witjh 
a slight slip or twist of one vertebra having great trouble. 

I wish to-day to continue this line of thought, taking up then, as the head 
of this lecture: The further consideration of the Osteopathic significance of 
points in diagnosis. I failed to explain fully to you the significance of the 
clicking in the neck. From what I said you may have gathered the impression 
that it has no significance, or very slight, as those noises which occur lower in 
the spine. Such is not the case, however; if you hear the click, the reason is 
because something has shut off the blood supply, it may have been a little strain, 
a congestion of the muscles, anything that will produce a tension over the blood 
vessles, or affect their vaso-motor fibers, causing a contraction and shutting off 
the blood. This may prevent the right amount of lubrication being deposited 
in the synovial membrane between the articular processes of the vertebrae, 
hence, you have the vertebrae too close together, and the patient in turning his 
head, or upon its being turned by the opeiator, elicits a click or grating, and 
the patient wonders what this is. To you such noises are of considerable sig- 
nificance. 

You may find it useful to consider the various troubles which you will find 
in your practice in relation to the plexuses from which they arise, and if you 
adapt yourself to the habit of thought, and at once think, when you see trouble 
in one part of the body, where they may have come from, what plexus is af- 
fected, and what region in the spine, I believe it will be of considerable use to 
3^ou. Now, there may be lesions of certain groups of nerves, — the upper cer- 
vical group of nerves, those from the first to fourth inclusive, may be affected 
by spasms, convulsions, or by paralj^sis in general, I wish to call your atten- 
tion to some points in relation to the distribution of nerves, and show you how 
important it will be to you as Osteopaths to have a knowledge which you can 
quickly call into use, of the distribution of the various nerves in the body. You 
may have a pain in the ear — the person whom it affects may describe it as ear- 
ache. If this ear-ache occurs upon the anterior pendulous portion of the ear, 
or upon the posterior aspect of the ear, you will have to refer that pain to the 
2nd cervical nerve, which supplies those parts. If the ear-ache is in the canal 
of the ear, or the upper anterior portion of the ear, you will have to refer that 
trouble to the 5th cranial nerve. Hilton states how it was that he happened 
to find so definitely just how these nerves were distributed to the ear. The 
case was that in which an attempt had been made to cut a person' s throat; 
the auricular branch of the second cervical nerve had been divided so that sensibil- 
ity had entirely departed from the posterior and lower parts of the ear. By prick- 
ing very carefully over the whole surface of the ear he found just the distribu- 
tion of the nerves. You may have the ear-ache and tooth-ache. And why? 
Simply because the 5th nerve supplying the auditory canal supplies also, by the 
superior and inferior maxillary branches, the teeth of the upper and lower jaws 



PRINCIPLES OF OSTEOPATHIC DIAGNOSIS. I^ 

respectively. You may have ear-ache associated with disease of the anterior 
third of the tongue, simply because the 5th nerve, which supplies sensation to 
the anterior third of the tongue also supplies the auditory canal. Pain in the 
anterior lateral part of the scalp, over the temples, pain in the face, eyes, nose, 
tongue, or teeth, you refer to this same 5th cranial nerve. On the other hand 
in case the pain is in the back of the scalp, we have two areas, one supplied by 
the great occipital nerve, and one by the small occipital branch of the 2nd cer. 
vical nerve. So it is that you have these areas of distribution given so that 
you can reason and thus refer pains in a particular part back to the origin of 
the nerves. Both the 5th nerve and these upper cervical nerves are readily ac- 
cessible to the operator. You thus see what the significance of these things 
are to the Osteopath in enabling him to make a correct diagnosis. If he is not 
acquainted with the distribution of these nerves he is not able to trace back 
and find the seat of the lesion. So it is by following correctly the distribution 
of the nerves you may fit yourself to make a correct diagnosis. 

In general the diseases which occur from lesions in the upper cervical re- 
gion are such troubles as torticollis, troubles with the phrenic nerve — hiccough, 
neuralgia, and troubles of that kind. Of course the Osteopath finds trouble 
with the phrenic nerve lower than the upper cervical group, generally arising 
from the 3rd, 4th and 5th cervical. When an Osteopath meets such disease as 
crutch paralysis, writer's, violinist's or pianist's cramp, he refers such cases to 
the plexus at some point, or to a lesion affecting it centrally, I remember a 
case of crutch paralysis which I treated. It was simply secondary from the use 
of a crutch, the crutch pressing upon the median nerve which comes from the 
inner and outer cords, thus affecting that nerve and consequently the thumb 
and first finger which are supplied by it. I^earn, then, to reason as to which 
plexus is affected. Having known this and how to treat it, your diagnosis will 
be correct, and you will be able to go understandingly about what you are try- 
ing to reach. 

Hilton considers diseases of the upper cervical vertebra among the most 
serious which may affect the spine. I quote from him as follows: "No cases 
of disease of the spine are so immediately dangerous to life as those of the upper 
part of the cervical region, especially if situated between the first and second 
cervical vertebrae." The reason of this is the close proximity of the bones to 
the spinal cord. There is danger of rupture of the ligaments about the odon- 
toid process of the axis, and in case this is ruptured or worn away by disease, 
the medulla may be impinged upon, thus affecting the centers located there, es- 
pecially the center of respiration, and so cause death. He instances a case 
which I have thought would be useful to you. He had a case of a lady who 
was affected thus: She had pains upon the left side of her head at the back, 
pains behind the ear, and over the clavicle and shoulder, pains and muscular 
paralysis of the left arm and deeper pain in the neck, which became apparent 
by pressure of the head straight down upon the spine and rotation of the parts 
there. He found that about the ist, 2nd and 3rd cervical vertebra there was 



20 PRINCIPLES OF OSTKOPATHIC DIAGNOSIS. 

some tenderness slightly more marked on the left than on the right. He an- 
ticipated, that there was a history of some accident, but could find none, as the 
lady knew of no accident that had occured. Her general health was very much 
affected; she was unable to work; for she had very sleepless nights, and her 
nervous system was very much affected in general. He diagnosed this case, of 
course, from the tenderness in the cervical region; he diagnosed it as a disease 
affecting the second cervical nerve, hence the pain is in the back of the head; 
he diagnosed it as affecting the 3rd, hence its distribution, also as affecting those 
parts supplied by the nerves which go to make up the brachial plexus. 

I simply bring this out to to demonstrate the need of accurac}^ in diagnosis, 
the need of reasoning closely along the lines of distribution of nerves. In this 
case Hilton found that the urine was affected, that it was ammoniacal, and 
a less skillful physician would have treated the case for bladder trouble, as in- 
deed often occurs. The point I wish to make is, that the Osteopath must not 
be carried astray by general symptoms. So where j^ou find foul urine, pain in 
the bladder, and things of that kind, you may be led astray; you surely wall be 
if you are not one who knows his business. It is the dictum of one of the old 
schools, I do not know which, to "Watch the symptoms carefully and treat 
them as they arise." And that has seemed to be the practice followed. But 
it does not need much reasoning to show you that should an Osteopath adopt 
such a course, he would rapidl}^ become a failure in his chosen profession. — 
There was a case here some time ago — a youug man from Springfield, 111., 
came here with one leg shorter than the other. He used crutches; he had a 
severe pain on one side of the knee of the affected limb. That man had travel- 
ed exstensively seeking help. He had been massaged and treated in almost 
every conceivable way; had lived in the hospitals for months. But one day he 
said to the physician in charge, "How does it happen that that leg is shorter; 
What is the trouble with that knee?" "Well," he said, "The bones may be 
separated and the tibia may have been pushed up, thus shortening that limb." 
If I remember correctly, that case was cured practically in one treatment. I 
do not say this to illustrate our quick cures. The treatment was sufficient be-" 
cause the muscles had been massaged, and were softened and ready to be work- 
ed upon. The hip was set. I became acquainted with the young man later. 
I realized what it was to have the deformity cured. He had been treated for 
years for the knee, but the trouble was in the hip. This is almost a threadbare 
illustration of what Osteopathy does; but it illustrates my point here perfectly. 
If you follow up the symptoms and treat them as they arise, you will land in 
obscurity. I do not wish to criticise any system of medicine, but from our 
standpoint it will not do for an Osteopath to work in that way. If he does, he 
is a poor Osteopath and does not understand what he is trying to do, and sim- 
ply makes what the "Old Doctor" calls an "engine wiper." He goes after 
the seat of pain, and not the seat of the trouble, and simply becomes a masseur, 
and, in his case, the criticism could justly be made, and that is sometimes claim- 
ed, that Osteopathy is nothing but massage. 



PRINCIPI.KS OF OSTKOPATHIC DIAGNOSIS. 21 

Dr. Hildreth brought out this same point some time ago. He mentioned 
two things that made up the success of the Osteopath. The first was in not 
being too rough in our treatment, but the one I want to call your attention es- 
pecially to was that Osteopathy makes correct diagnoses. It goes back to the 
original cause, and does not depend upon symptoms merely. 

I wish to call your attention to the following point: That pain upon the 
surface of the body, not accompanied by any rise in temperature, indicates a 
distant origin of the trouble, and that trouble is usually in the spine. 

Hilton says that if this pain be upon the cutaneous surface then it will in- 
dicate spinal disease in every case. I have had a drawing put here showing ' 'a' ' 
and ''b," the distribution respectively of the 6th and yth dorsal nerves. They 
meet'over the pit of the stomach in the skin, and will refer a pain to that point. 
The patient thinks the trouble is there; his trouble is invariably at the spine. 
He, of course, will want you to treat the affected spot. There is a case on 
record of pain in the pubes and over the lower part of the abdomen, the physi- 
cian finding the trouble in the lower part of the spine, it being associated with 
paralysis of the lower limbs, decided it was spinal trouble and rubbed an oint- 
ment on the spine. The patient thinking the symptoms should be treated, 
rubbed the ointment over the lower part of the abdomen, being paid for his 
interference by a great deal of smarting. He wanted to treat the seat of the 
pain instead the seat of the lesion. It is true that these pains are not mere 
happen so' s. They depend upon a close connection, as in this case, of the 
nerves; this close connection may be either through the spinal nerves or it may 
be through the sympathetic system. You may have a pain at a part, which 
you may trace up through a nerve, back up through the cord to the brain or 
center, down another nerve to the original cause; so that an original cause may 
act along a nerve through a center and down through another nerve, so that 
that the seat of the pain is not the seat of the lesion. If such a patient comes 
to you, do not become a masseur; do not treat the seat of his pain, but treat 
the seat of the lesion causing the trouble, and convert him by showing him 
true Osteopathy. 

A peculiar phenomena is often witnessed. You may come across a case 
in which one part of the body is more sensitive than another; you may have 
paralysis, both muscular and sensory, below an injured part, with acute hyper- 
esthesia above. The explanation which has been given in such a case is two- 
fold. In the first place take such a case as a fracture of the spine; of course 
the parts about the site of the injury are the seat of the inflammation: after the 
fracture the parts are engorged with blood; there are exudations, both fluid 
and cellular, about the parts, which may press upon the origins of the nerves 
just above the seat of the fracture and may irritate for a considerable distance 
up in the spine, thus causing considerable sensation above. Below the nerves 
have been injured by the trauma to the cord. The other explanation is chiefly 
the same except that in it the origin of the spinal nerves is taken into consid- 
eration; as you go further down the spinal coluam you will find that the roots 



22 PRINCIPLES OF OSTEOPATHIC DIAGNOSIS. 

run more and more obliquely in the canal, until finally the lower ones run an 
inch and a half or an inch and three-quarters before emerging. And of course 
when the impingement is upon the origin of those nerves, the pain will beat 
their distribution upon the muscle and surface of the body. I had a case simi- 
lar to this— a man who is still in town for treatment. He has paralysis of the 
lower limbs, almost a complete lack of muscular ability and also almost com- 
plete lack of sensibility in the lower limbs. The lesion appears to be in the 
lower part of the spine. I say "appears to be," because there is another place 
higher up in the spine which may be the cause. But taking it as the lower 
one, he has a terrible itching and smarting along the spine; upon treatment, 
however, he readily recovers from these symptoms. Now, the explanation 
may be similar to that given, and it may partake of the reasoning that I gave 
you the other day concerning Osteopathic matters. That is, that there 
is too much life above, and there is too little life below; something has interfer- 
red to cut off nerve and blood flow below, while that above is supplied with 
its full quota already and does not need that which is misdirected to it, thus 
there is irritation to the parts above and the resulting symptoms. What the 
Osteopath does is simply, as was indicated before, to try to restore the equili- 
brium of nerve and blood forces to the lower parts of the body which are suffer- 
ing, and then to the parts which are impinged upon above. To do this he sim- 
ply goes back to the parts affected. 

Q. In the event of peripheral trouble, sensation, would j^ou also find the 
sensation at the origin? 

A. Not necessarily. You might not have any sensation there. Other- 
wise; the patient would have himself perhaps discovered it. You may not have 
a sore spot at all; it may be such a lesion as spreading of the spines or approx- 
imation of the spines, not necessarily any tenderness at the central, at the 
lesion. 

Q. Are there no exceptions to the rule that where there is pain on the 
surface, accompanied with rise of temperature, the trouble is of spinal origin? 

A. I took Hilton as authority there, and he gives this example. It is 
just as invariable as in the case of inflammation, in which the principal sign is 
rise of temperature; you may have the sw^elling and the pain with out the inflam- 
mation, but if you have these two and heat also it is a sign of inflammation. He 
makes a parallel and says it is just as invariable that if there is pain upon the 
surface of the body, not accompainedby rise in temperature, the cause is of spin- 
al origin; he does not make any exception. 

Q. I understood j^ou to say that the 5th nerve was reached through the 
sympathetic? 

A. The 5th cranial is reached through the superior cervical ganglion. We 
get results which justify us in saying this; any operator will tell you that he 
gets results from the superior cervical that influence the 5th nerve. Of course 
he does it by sympathetic connection, which I will explain at another time. 

Q. In the case of that man with the pain on the inside of the knee, sup 



PRINCIPLES OF OSTKOPATHIC DIAGNOSIS. 23 

pose that he should have had localized trouble at the knee, would you have 
recognized the condition b}^ the lesion in the spine? 

A. Yes, partly, and you would have to go into the history of the case. 
You would have to go back to your centers and determine what was the trouble. 

The first thin^ would be to go to the spine and thoroughly examine; if you 
find a lesion there, the probabilities are it is of spinal origin. You should by 
all means whenever you have such a case, or any case, go back to the center of 
the nerve supply, and you may find the lesion there, above or below the center, 
or you may not have a distinguishable lesion. 

Q. In the event of a severe gastritis would there be a soreness in the 
spinal region? 

A. Very likely there would be, and in that case your soreness and con- 
gestion of the muscles would be what I have explained as secondary. 

Q. Which would be secondary? 

A. The congestion of the muscles along the spine. In a case of severe 
gastritis you would very likely find sore spots along the spine. The explana- 
tion being that the nerve influence from the disturbed stomach travels along 
the sympathetic branches of the solar plexus back to the spinal connection of 
those nerves, and then passed through to the peripheral termination of the 
spinal nerves in the muscles of the back. 

Q. Is it true that you can designate which organ of the bod}^ is in trouble 
by finding the tenderness in certain spots in the spine? 

A. Yes, in general that is true. I thought I brought that point out in 
my last lecture. The sore spots may be due to either peripheral or central 
trouble, *and by determining whether they are primary or secondary you may 
locate the trouble by reasoning from the center to the periphery. 



LECTURE VI. 

At the last lecture I called your attention to the further significance of the 
the clicking in the neck, stating that it frequently meant a lack of lubrication 
secreted in the synovial membranes. I began to take up the general effects of 
lesions of plexuses along the spine, taking up the first group, the upper four 
cervical nerves. I called your attention to the fact that pain must be referred 
to the origin of the nerve supplying a part, instancing the anterior pendulous 
portion of the ear and the posterior portion of the ear as being supplied by the 
second cervical nerve, versus pain in the other parts of the ear indicating lesion 
in the fifth cranial nerve. Hilton considers diseases of the upper cervical por- 
tion of the spine among those most dangerous to life. The operator must not 
confuse symptoms with causes. He must not take, for instance, some symptom 
which may be prominent, thinking it to be one of the first causes. If there is 
pain upon the surface of the body not accompanied by any rise in temperature, at 
indicates disease of the spinal region. A peculiar phenomenon often witnessed 



24 principi.es of osteopathic diagnosis. 

is that there is paralysis of sensation, or motion, or both, at a point below a 
spinal injur}^, while there is acute hyperesthesia just above. The explanation 
was given that it was owing in part to the obliquitj^ of the course of the spinal 
nerves, in part to the engorgement of the parts and the exudations, fluid and 
cellular, which takes place around a serous lesion of the spinal cord. To-day I 
wish to pursue this line of thought somewhat further, hoping to finish in this 
lecture. That is, this general point of the significance of general symptoms to 
the Osteopath. 

I. Further consideration of Osteopathic significance of points found in 
diagnosis. 

The lower four cervical nerves and brachial plexus constitute what is 
known as the second group of nerves. The brachial plexus sends short branches 
to the shoulder and upper intercostal muscles, and long branches to the arms. 
In general the effects which may follow lesions to the second group of nerves 
a/e paralysis, spasms and neuralgias. Such troubles the operator must learn 
to refer back to the center; that is, to the origin of the plexus along the spine. 
Should you have palsy of the hand, or edema, which is neurotic in origin, such 
cases you must refer to trouble in the brachial plexus. Of course this is speak- 
ing of these nerves as members of the cerebro-spinal system. Please remember, 
also, that the first Rroup of nerves is connected with the upper cervical gang- 
lion of the sympathetic, and that the second group of nerves is connected with 
the second and third ganglia of the sympathetic, and that in case the lesion be 
severe enough to affect sympathetic life, you may in lesions in this region have 
far-reaching disturbances. Remember also that from the third, fourth and 
fifth cervical nerves arises the phrenic nerve, and that injury here may cause 
diaphragmatic trouble; hiccoughs for instance, which we treat in that region. 

The third group of nerves is composed of the twelve doisal nerves. Of 
these the first six are connected with the first six dorsal ganglia of the sym- 
pathetic, and the last six but one are connected with the remaining six dorsal 
ganglia of the sympathetic. In their capacity as spinal nerves the members of 
this third group are subject, usually, to merely sensor}^ affections. Thus you 
will frequently come across in your practice, cases of intercostal neuralgia. 
This the Osteopath diagnosis, and is usually correct, as a pressure upon the 
nerves, caused by crowding together of th2 ribs. Later, when we come to take 
up the consideration of the thorax, 3^ou will find that we make prominent the 
point that the ribs are dropped together frequently or are drawn together, and 
you will learn to reason thus, as in the case of intercostal neuralgia, from the 
Osteopathic point of view. Lesions here may also cause herpes zozter, com- 
monly called shingles, a nervous affection caused by eruptions upon the skin. 
From their sympathetic connections this group of nerves may be associated 
with troubles of the pleura or lungs, and with sympathetic troubles of the vis- 
cera, as 5^ou know the splanchnic nerves run from the sympathetic connections 
of the dorsal nerves to the various viscera of the body. 

The fourth group of nerves is composed of the five lumbar nerves, the up- 



POINTS IN OSTKOPATHIC DIAGNOSIS. 25 

per four of these nerves, with the twelfth dorsal are connected with the upper 
four lumbar ganglia of the sympathetic. Diseases which may affect these 
nerves as members of the cerebrospinal system are mainly neuralgic. Of course 
you may have paralysis or spasms, but you are not so liable to have them as in 
lesions of the nerves of the cervical or sacral region. Sym^pathetic troubles of 
course would occur according to the centers with which these nerves are con- 
nected. 

The fifth group, finally, is that composed of the five sacral nerves. These 
five sacral nerves, with the fifth lumbar, are connected with the five sacral 
ganglia of the sympathetic. lycsions affecting these spinal nerves are such as 
affect the cervical nerves in general, that is, paralysis, spasms, and neuralgias, 
which may vary greatly in character. You may have tonic or clonic spasms 
of the lower limbs; you may have neuralgia, such as sciatica; or you may have 
paralysis of the lower limbs. Sympathetically, of course, you would refer to 
such troubles as are indicated in the outline of centers given. 

I have thus taken up the grouping of the nerves along the spine. Of course 
it has been very general. The purpose has been to give you a general view of 
regions affected, and to give you a general idea of how the Osteopath looks at 
disease; that is, he reasons from periphery back to center. My treatment of 
the subject has necessarily been general, leaving aside a more particular view 
until such time as we shall take up these different affections which we meet, 
more in detail. I may in these last few lectures have been a trifle obscure; I 
find it a rather difficult subject to elaborate and, being so general, it may have 
been indefinite. Still I trust' that it may have fulfilled its object, which was, 
briefly as follows: In the first place, to indicate to you the necessity of keep- 
ing separate in your mind the cerebro-spinal system and the sympathetic system. 
Remember that you cannot separate these entirely, but look for symptoms from 
the one and look for symptoms from the other, one is a cerebro-spinal vi'^w and 
the other a sympathetic. You do not really find them so separated in j^our 
practice. Second, to impress you w'ith the importance of diagnosis based ac- 
cording to centers affected. Third, to teach you not to confound incidentals 
with essentials; not to mix mere symptoms with causes of disease. I thought 
I could thus indicate to you, that Osteopathic point of view, that Osteopathic 
habit of mind in looking at disease. 

Hilton states that as a rule pain in disease of the lower cervical, dorsal 
and lumbar regions is indicated by pains symmetrically upon the surface of 
the body. That in the upper c:rvical region being not indicated synunetrical- 
ly by pain upon the surface of the bod}'. The original cause for such pains 
we would look for, of course, in a central lesion. If the trouble be bi-lateral, 
located on each side of the bod}^ we would look for a central cause, or perhaps 
the cause may be bi lateral, I instanced a case at the last lecture of pain over 
the skin a,t the pit of the stomach, being referred back along the course of the 
nerves to the sixth and seventh dorsal vertebrce. Hilton instances a case in 
which a boy had severe pain there; he went about stooping, holding his hands 



26 POINTS IN OSTEOPATHIC DIAGNOSIS. 

over that region. Upon lying down the pain disappeared to some extent. His 
diagnosis of that case was that there was trouble at the sixth and seventh ver- 
tebrse, and he found disease there of such nature that it exerted pressure upon 
the sixth and seventh nerves upon both sides. Another case similar, was more 
complicated in that it led to vomiting. Almost any physician would have diag- 
nosed such a case as stomach trouble, no doubt. Hilton, however, upon exam- 
ining the tongue found no indications of stomach trouble, and diagnosed that 
case also as disease of the sixth and seventh vertebrae, directed treatment to 
those points, and was successful in curing the case. Sometimes in such di- 
seases we find a pinching feeling about the body, a feeling as if the body were 
girdled. Now, as to the reasons why the pains are symmetrical in these parts 
of the body I have already indicated. But why the}" do not occur so above is 
simply this: The difference in the nature of the vertebrse. Thus, below the 
second cervical, the vertebrse articulate with each other by their bodies and ar- 
ticular processes, but above that point it is different; the atlas articulating with 
the occiput by just two points, and one might be affected without communica- 
ting with the other. The articulation of the atlas with the axis is by just three 
points; the odontoid process articulates with the anterior arch of the atlas, and 
the bodies by the articular surfaces. Now, any one of them may be affected, 
and it is the rule that one of these is affected without communicating the dis- 
ease to the other. Thus you may have a symmetrical distribution of the pain. 

A further point of importance is that if a certain organ is affected the im- 
pulse may be transmitted sympathetically from it and reflected to another or- 
gan, and that always in such a case it is carried to that organ connected most 
closely by nerve strands to the organ first affected. Bryon Robinson says that 
ganglia of the sympathetic, especially the cervical ganglia and the abdominal 
brain, are points of reorganization of impulses sent to them, and of redistribu- 
tion of these reorganized influences or impulses, which are sent to various vis- 
cera, in general, to those most closely affected, those which are furnished with 
the greatest number of nerve filaments. I quote him as follows: "It is a 
principal in physiology that when a peripheral irritation is sent to the abdomi- 
nal brain, the reorganized forces will be emitted along the lines of least resist- 
ance, so that the organ which is supplied with the greatest number of nerve 
strands will suffer the most." He cites here a prominent instance of uterine 
tumor affecting the heart, and in this way, that the influence of the uterine 
tumor upon the hypogastric plexus was reflected back through the solar plex- 
us, where it was reorganized and sent out along the spalchnics to the superior 
cervical ganglion and the next two below it, and was then sent out along the 
three cardiac branches to the heart, thus causing an irregularity of the heart, 
leading finally to heart disease. This point is of great importance to the Os- 
teopath. You will find it very common in your practice to find a case of 
uterine trouble resulting in headache. Thoroughly apply any of the ordinary 
methods of treatment to the headache, and they will certainly be unsuccessful. 
You must learn to diagnose with these things in mind, and to reason according 



LANDMARKS OF THE SCAPUI.A. 27 

to the connection of these parts through the sympathetic system. Now, in the 
instance given, the impulse might have been sent differently. It might have 
passed from the hypogastric plexus to the solar plexus, being there reorgan- 
ized and then sent out to other viscera throughout the body, as is frequently 
the case. Or it might have run up through the sympathetic cord, reaching 
the medulla, then affecting the vagi nerves, resulting in stomach trouble. 
Another illustration I take from him. He calls to mind the fact that the kid- 
neys, ovaries, uterus and fallopian tubes of the female are developed from the 
Wolffian bodies in the embryo. They are thus closely connected in nerve and 
blood supply, and it is a fact that uterine trouble results often in kidney 
trouble, and kidney trouble may very readily result in uterine trouble. In 
such a case it is difficult to diagnose the case according to the symptoms, and 
to determine what must be the original cause. These secondary symptoms are 
frequently quite prominent, and treatment directed to them will not necessarily 
have any effect upon the original trouble. 

II. Landmarks concerning the scapula. Holden instances the following 
points concerning the scapula. First, that it covers the ribs from the second 
to the seventh inclusive on either side; that its superior angle is beneath the 
trapezius muscle; that its inferior angle is beneath the latissimus dorsi muscle; 
this latissimus dorsi binds the posterior edge of the scapula closely down 
against the posterior chest-wall in a strong person. In case of consumptives 
the scapula is allowed to project outward at its lower angles, and this give the 
peculiar appearance which is called, ''scapulae alatse." A horizontal line from 
the sixth dorsal spine to the inferior angle of the scapula outlines the superior 
margin of the latissimus dorsi muscle. A line drawn from the root of the 
spine of the scapula down to the twelfth dorsal spine outlines the inferior bor- 
der of the trapezius muscle. In examining a back it is convenient to have the 
patient sit leaning forward with the hands hanging between the thighs; this 
brings the spine of the scapula down about the third intercostal space, on a 
level with the fissure between the upper and lower lobes of the lung. 

III. How TO Treat a Spine: — Having learned how to examine a spine, 
having learned also the significance of points one finds along the spine in his ex- 
amination, the next question naturally is, how to treat these points when observ- 
ed. I am indebted to Dr. Eastman for calling my attention to the fact that often 
these noises which we may find in treating along the spine are of pecular sig- 
nificance in this way: That he says he has often pushed ribs back into place 
which had been slipped, simply by this pushing motion along the spine. In 
our treatment of a spine there are two points which we may take into consid- 
eration; two objects which we may have in view. In the first place, we may 
wish to treat the spine per se, treat the spine stself. In the second place, we 
may wish to reach, by treating the centers along the spine, the viscera to 
which these nerves run. It is not always possible to dissociate these in your 
practice. Indeed, this is more a separation of convenience. I have divided 
these points thus simply for convenience in the consideration of them. You 



28 HOW TO TREAT A SPINK. 

will of course, in practice not be able to separate the results upon the spine 
itself from the result which you will get upon the centers when working along 
the spine, but the Osteopathy of it is the same, and I trust will be made clear 
to you by this division. 

Now, when you are treating a patient, one very good way to treat the 
spine, to get everything relaxed, is simply to lay the patient on his face. The 
patient, usually thinks he is relaxed when he may not be. I think those of you 
who are familiar with Delsarte methods will agree with me. Your first care is 
to see that the patient has become fully relaxed. Now, we wish to learn how it 
is that we ma}^ affect the central distribution of the sympathetic nerve. I spoke 
to you the other day of the gray rami communicantes extending from the gan- 
glia of the sympathetic back to the spinal column, supplying the blood vessels 
of the dura mater and of the vertebrae, and the ligaments. Thus, is you wish to 
treat the spine itself, wish to strengthen it, of course j^ou must necessarily di- 
rect you treatment to reaching these vaso motor nerves in order to relax and 
allow sufficient nutriment to be sent to these parts. In order to do this you 
must always first loosen all the contractions of the muscles along the spine. 
Very frequently you will find that the muscles are contracted unevenly and slip 
under your fingers. That is a test; a muscle may be hard, as it naturally is, 
from exercise; then the hardness is homogenous. The first point, then, is to 
loosen up the muscles, and in doing this it is well to bear in mind that you 
must work against the course of the muscle fibers, the deeper ones especially. 
It is perhaps easier in that way to get a relaxed effect, and your idea should 
be to work in such a way as not to hurt the patient. You may treat so hard 
and so roughly as to damage. The motions that I may make, or the faces that 
Dr. Hildreth makes when he is treating a patient, are not any indication of 
the amount of force used, that is a habit, and the thing you should guard 
against is too rough treatment as you may injure delicate parts. In seeking to 
relax a nerve you may irritate it, and thus cause the muscle to shrink. You 
should not manipulate with the tips of the fingers, you should turn the fingers 
so that the cushion of the finger does the work, and in that way thoroughly re- 
lax all the congested or contracted muscles along the spine? 

What if you do not have any contracted muscles there? That, of course 
is the condition in many cases. It is our work in such a case where the mus- 
cles are flabby and there is a lack of tone, to stimulate all along the spine and 
thus to tone up the parts. Do not be afraid of being thorough in this matter. 
You must relax all the muscles there from the occiput to the coccyx, as they 
may any of them produce sympathetic troubles which may be reflected over a 
considerable portion of the body. 

There is a certain amount of hair splitting done over the terms of desensi- 
tization and stimulation. Their significance I will take up later, but always 
bear in mind that your first point must be to relax contracted muscles if you 
find them; if you do not find them your work should be directed toward reach- 
ing the deeper structures mechanically and securing an equal distribution of 



HOW TO TREAT A SPINE. 29 

nerve force. - If there are contractions, no matter what your final treatment is 
to be, you must get rid of those contractions first. While the patient is upon 
his face there is an important effect which we get upon the spine itself. Of 
course we cannot separate this really in our practice, that is, the work along 
the spine has its effect upon the body according to the centers reached. Sup- 
postf I wish to reach the center going to supply the nutrition of these parts, I 
spring the spines up, using the arm as a lever, and by so doing you can exert 
a grea^ deal of force. Drawing up the arms raises the ribs, and at the same 
time, by springing the spine I can get a considerable force all along the spine 
This is one way. Another way is to draw the limbs up; you will find this a 
very convenient method, this of course will bow the back and make prominent 
the spines, then you can readily reach under, and in that way you can spring 
the spine or any part of it; and it is always advisable for you to stretch the 
spine in that way rather than to attempt to stretch the patient by pulling the 
neck; that is a tensile strain upon the spinal column, and of course it resists 
more than it does a lateral force. You will find this useful in your practice. 
There is another method which we frequently use: getting one elbow down 
against the upper edge of the pelvis, and the other against the prominent part 
of the shoulder, and separating them, also reaching over the spines of the ver- 
tebrae, you relax all along the spine. When you have done this upon one side, 
repeat it on the other. And why? Because when you spring the spine in this 
way all along you have stretched the ligaments upon that side, but you have 
not stretched the others. You cau readily see that as I spring these spines the 
effect must be to stretch the ligaments on the convex side, and to relax the 
ligaments on the concave side of the curve. So you must turn 
the patient over, treat the other side, providing you wish to 
treat the ligaments upon both sides of the spine. You may treat the muscles 
alone in this way. When you have that object in view, which depends upon 
your case, usually you must exert considerable force, but do not dig. Do not 
use the end of your finger. You can develop strength so that 3'ou can keep 
the finders flat and work with the cushion of the fingers against the muscle, 
and in this way you can get a very good effect upon the muscles themselves. 
Do not be afraid, but keep at it until they are relaxed; do not treat too hard or 
you may stimulate, and they will contract more, but by deep work along the 
spine you may have a soothing effect upon those nerves and thus cause them to 
relax. What has been the object of this work? Simpl}' this, that by relax- 
ation of the contracted muscles or by stimulation of those weak, flabb\' muscles, 
you have succeeded in drawing new life to that spinal column, and in that way 
you have made your first step toward reinstating the strength of that debili- 
tated spinal column. 

O. Is a simple manipulation there enough to relax the contracted mus- 
cle? '^ 

A. Yes, simple manipulation is enough if rightly applied. 

0. Is a dislocation of a vertebra liable to cayse giddiness? 



30 EXTERNAL MANIPULATION FOR INTERNAL RESULTS. 

A. It may very readily. It may act in such a way as to shut off the 
blood supply to the brain, 

Q. More likely the cervical vertebrae? 

A. Yes, more likely in the cervical region. Or it might act in such a way as 
to cause retention of the blood in the head and result in dizziness. 

Q. Did Dr. Eastman say that a rib displaced was the cause of a noise 
along the spine? 

A. As he pushed the rib, and as it went back into place it made the 
noise. 

Q. If you had a patient who was unable to raise his hands above the level 
of the shoulder, and there was pain at the insertion of the deltoid muscle and 
also over the shoulders, where would you look for the trouble? 

A. I would look for the trouble in the brachial plexus, the origin of the 
circumflex nerve, supplying the deltoid muscle. 



LECTURE VII, 

At the last lecture I took up further consideration of the Osteopathic sig- 
nificance of points found in diagnosis. I called 3^our attention to the troubles 
which maj'^, in general, affect the lower cervical group of nerves; those which 
affect the brachial plexus, for instance, being chiefly spasms, neuralgias and 
parah^sis. Also, I called your attention to the connection between those nerves 
and the sympathetic ganglia; also the connection of the third group, the dorsal 
nerves, except the twelfth, with the sympathetic dorsal ganglia; the diseases of 
this group being chiefl}^ sensory. I then spoke of the connection of the fourth 
group, the upper four lumbar nerves and the last dorsal, being connected with 
the five lumber ganglia of the sympathetic; the diseases of the fourth group be- 
ing chiefly neuralgias, and not spasms or paralysis, although you might find 
them in that group. Spasms and paralysis, as well as neuralgia, being more 
commonly found in the fifth group; the five sacral nerves and the last 
lumbar being connected with the sacral sympathetic ganglia. I also traced in 
general the connection between these plexuses and diseases which might orig- 
inate there, stating that my object in the last two lectures had been to aid you 
to keep separate the cerebro -spinal and sympathetic systems, to diagnose di- 
eases according to centers, and to teach you to separate non-essentials from es- 
sentials. I instanced this rule of nerve force, that it is emitted along the path 
of least resistance, and that, sympathetically, the organs most closely connected 
by nerve-strands with the organ affected is most apt to suffer; that, in the send- 
ing of such impulses along the paths of the sympathetic system, certain centers 
such as the abdominal brain, are centers for reorganization of those- impulses, 
so that, being reflected to these centers, they are sent out reorganized, I then 
drew some illustrations to account for phenomena witnessed according to this 
law. I then called your attention to landmarks concerning the scapula, and to 



STIMULATION AND INHIBITION. 31 

treatment of the spine. That being the question you naturally ask after having 
learned to examine the spine. The generel points brought out being that there 
is a treatment upon the spine itself, and a treatment of the spine for further 
reaching effects, chiefly through the sympathetics, upon the internal viscera. 
And I showed you, by laying the patient upon his face and upon his side, what 
was the technique of manipulation that we employ, I shall, in the latter 
part of this lecture coptinue that subject. I have thought that for the 
first part of my lecture today it would be helpful to us to consider the Osteo- 
pathic theory of work upon centers. 

I. How does the Osteopath by external manipulation upon the surface of 
the body affect internal nerve life? How can he reach centers in the spine, or 
nerve centers in any part of the body? What does the Osteopath mean when 
he says that he stimulates, or desensitizes, or inhibits nerve action? Those are 
great questions. It is needless for me to say to you that they lie at the 
basis of our science. It is not a question as to fact. The facts are already 
proven beyond a doubt, but it is a question of finding a rational scientific expla- 
nation of facts, of establishing theories which lie back of our work. Osteopaths 
have different views concerning these matters. They answer these questions 
differently. I called upon the different operators in the building to give me a 
synopsis of what their views were. There were some w^ho said they were not 
able to explain satisfactorily some of these things, and there was also some dis- 
agreement in their answers. I simply wish to add my little mite, not at all 
supposing that it will solve the questions for all time. There are, however, cer- 
tain facts in relation to these questions which I thmk will be profitable to call 
to your attention, and I will also make some reference to the answers which I 
have received from the old operators whose experience has been wider than 
mine. Remember, it is not a question of "Do you do this? Do you accom- 
plish such results?" but granted that the results are accomplished, which is 
true, "how do you accomplish them?" In approaching this question we must 
clear away all misapprehension as to definitions. Do we, when we say ''de- 
sensitization," etc., mean the same as the physiologists mean when they say de- 
sensitization, stimulation, etc., and can we, in the generally accepted view, 
have such an effect upon the nerve as to desensitize or stimulate them? For 
this reason I will first define these points according to the physiological view, 
and then according to the Osteopathic view. The physiologist uses these terms 
in two senses. First, in the usual normal sense; a normal impulse sent from a 
center along a nerve or from a periphery along the nerve, resulting in function. 
For instance, an impulse is sent from the brain along a nerve causing the con- 
traction of a muscle. Again, a sensation of pain comes from the peripherv to 
the center, which thus receives it, and there is a sense of pain. In this case 
there was a stimulation of a sensory nerve by the agency producing the pain, 
no matter what that agency was. For instance again, the normal and contin- 
uous inhibition of cardiac action through the vagi by the impulse sent from the 
brain. Now, that is the normal and usual sense in which these terms are used. 



32 THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 

The second sense in which these terms are used by phsiologists is irritation of 
a nerve, and thus its stimulation or inhibition of function by physical agencies, 
as heat, cold, electric current, application of pressure or tapping, or the appli- 
cation of chemicals. That is what he means when he says he has acted upon a 
nerve, has experimentally treated a nerve. He may, for instance, apply a 
caustic and elicit a sensation of pain, and state that he has stimulated the nerve. 
He may for instance again, apply an electric current, stimulate the nerve and 
cause muscular contractions. Or, finally, he may by pressure or tapping upon 
the nerve, carried to the point of exhaustion, secure the result of paralysis, 
that is, inhibition of the nerve action, resulting in the loss of sensation or of 
motion, or of both. He then says that he has "inhibited," desensitized the 
nerve. He thus by the use of ph3^sical agencies produces such results similar 
to the normal, for instance, the contraction of muscle, and he reasons that the 
impressions aroused by such agencies are similar to normal; he has really stim- 
ulated, or inhibited. For instance, he by some ageuc}^, the use of an electric 
current, so stimulates the periphery of the sciatic nerve that he gets a vaso- 
motor effect in the nerve. He reasons that, as he has stimulated the nerve 
£bres in a manner similar to normal, therefore there are sympathetic vaso- motor 
fibres in the sciatic nerve. This was the actual method employed in determin- 
ing that vaso-motor fibers were contained in the sciatic nerve, and this was ac- 
cepted by the authorities. I believe that I have thus correctly represented 
the views of the physiologists in the definition of these terms. 

Second —How does the Osteopath define these terms? What does he mean 
when he uses them? He uses them, of course, in the the normal, physiological 
sense, which we will leave aside. He also uses them in another sense, which 
for the present we will leave aside also. But the question to-day is, does he by 
a physical agency, that is, by manipulation, by pressure, by tapping, and 
stretching, all of which he uses in effecting nerve filaments or nerve centers, 
produce a result similar to normal, and may he be with the physiologist, allow- 
ed to reason that therefore the impulse which he has aroused by the use of 
such physical agencies is similar to the normal? A pressure on the phrenic 
nerve controls the spasms of hiccoughs. The result of the use of such physi- 
cal agency is similar to normal, hence the impulse must have been similar to 
-normal. Again, by rubbing the neck in the region of the superior cervical 
ganglion, he stops bleeding from the nose, and produces an effect similar to 
normal, "hence the vaso-motor influence generated by irritation in that region 
must be similar to normal. He says he inhibited the phrenic or stimulated the 
superior cervical ganglion. We must allow him equally with the physiologist 
to say that he has stimulated, or inhibited the nerve in question. ]>^ow, the 
question at once arises, what was the manner of the application of those physi- 
cal agencies? Does the physiologist, as well as the Osteopath apply these 
agencies externally? Of course if there is a difference in application, then our 
reasoning would not hold good. But my reply here is, yes, he applies them ex- 
ternally, though not always. Still, if he, the physiologist, does it only some- 



THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 33 

times, and obtains results which justify him in saying that he has really stim- 
ulated or inhibited, the case is proven for the Osteopath, even though the lat- 
ter works externally always, providing only that the Osteopath obtains as wide 
range of results as does the physiologist, who works both externally and upon 
the exposed nerve or center. That the Osteopath, by his means obtains results 
in every part of the body is shown by cases upon record. 

I wish to quote from text books to show that the physiologist does work 
externally upon the body to produce his results. In the first place I quote 
from Dr. Lombard, Professor of Physiology in the University of Michigan, in 
Howell's American Text Book. "If pressure be brought to bear on the ulnar 
nerve where it comes across the elbow, the region supplied by the nerve be- 
comes numb " Now in the context he explains that everyone has occassion to 
demonstrate this upon himself, evidently implying that external pressure was 
used. Dr. W. T. Porter, M. D., Assistant Professor of Physiology in Harvard 
Medical School, in the same text book states as follows: "The reflex action of 
the sympathetic nerve upon the heart is well shown by the experiment of F. 
Goltz on a medium sized frog; the percardium was exposed by carefully cutting 
a small window in the chest wall. The pulsations of the heart could be seen 
through the thin pericardial membrane. Goltz now began to tap upon the ab- 
domen at the rate of about 140 times a minute with the handle of a scalpel. 
The heart gradually slowed and at length stood still in diastole. Goltz now 
ceased the rain of little blows. The heart remained quiet for a time, and then 
began to beat again, at first slowly and then more rapidly. Some time after 
the experiment, the heart beat about five strokes in the minute faster than be- 
fore the experiment was begun. The effect cannot be obtained after section of 
the vagi." 

I have thus quoted at length to show with exactness the manner of exper- 
imentation and the external application of this physical agency which was em- 
ployed. Agai-n, the physician in applying the electric current to a living pa- 
tient for the purpose of diagnosis or treatment, applies the same externally. I 
■quote from Dana. "Statical electricity is applied from fifteen to twenty min- 
utes daily or tri-weekly. For general tonic or sedative effects, sparks are drawn 
from all parts of the body except the face; in paraiysis or spasms of pain, sparks 
are applied to the affected area. Tn general electrization, whether galvanic or 
faradic, the indifferent electrode is placed on the sternum, feet or back and the 
other pole is carried over the limbs, trunk, neck, and if indicated, the head." 
In this course of the argument I wivsh to instance what I heard Dr. Eckley say 
once concerning the surgical method of treating sciatica. He said that an in- 
cision was made through the gluteal muscles down to the nerve, laying it open 
to view; that a hook was then used, and the nerve stretched with a force of 
about forty pounds, that is, sufficient to raise the toe of the patient from the 
table, the patient lying on his face. That was the surgical method of stretch- 
ing the nerve to relieve cases of sciatica. He also went on to say that the 
method used nowadays is that of flexing the thigh upon the thorax, thus giv- 



34 HOW TO TREAT THE SPINE. 

ing a strong tension to the nerve, and that is the treatment used to-day by phy- 
sicians for the cure of sciatica. You will see that that was external manipula- 
tion, that the application of electrical current was external, the tapping upon 
the abdomen was external, and the pressure upon the ulnar nerve was external 
I have simply endeavored to show that the Osteopath m treating nerves and 
centers emplo^-a physical agencies externally. In one case the physiolo- 
gist is allowed to say, and it is accepted by the authorieties. that he has stimu- 
lated a nerve, stimulated nerve action by this means, and inhibited nerve ac- 
tions by this means, and my argument is, therefore, that in the same manner 
the Osteopath must be allowed to say that he has stimulated or inhibited 
nerve force, and that we therefore use these terms in the generally accepted 
manner. This is my view of the subject, and I believe my conclusions are 
reasonable and fair; that from the results accomplished, means employed, and 
manner of application of the physical agency by the phj^siologist and b5^ the 
Osteopath, the latter is as much entitled as is the former to the use of the terms 
stimulation, and inhibition in their generally accepted sense. 

I shall follow this subject further for a lecture or two. There are many 
points in relation to the work upon nerve centers which are obscure, and 
which I think I can with value attempt to illustrate before you. 

II, How TO Treat a Spine. (Continued.) — Whereas, the last time I 
gave you the treatment for the spine itself, to-day I will take up the con- 
sideration of treatment of the spine for distant effects. The point here is, 
that we may not only treat the spine, with the patient upon his face, for im- 
mediate effects to the spine, but we may treat to reach viscera through the 
sympathetic nervous system. Your first object is to relax all the structures 
as in the other case, for the reason that tension here in the muscles may af- 
fect a center, it may affect not only the center which relates to the spine it- 
self, but a center, for instance, the splanchnics, controlling the stomach, or 
the kidneys, or the bladder, or some of the internal viscera. You will very 
commonly find sore spots along the spine. The indication is usually that 
they are the seat of lesions. We reason, then, according to the sore spots. 
or according to the contraction of the muscles, or according to the separation 
of the vertebrae, or whatever the lesion may be, to the centers of the sympa- 
thetic affected. If we know where the different centers are situated along 
the spine, and find a lesion at a certain point, we can reason what the result 
would be, or vice versa, by finding a certain disease manifest in the body we 
can trace back from the disease to the center, and expect to find a lesion at 
or near that center. For instance, suppose I had examined this gentleman 
and found that he had lung trouble, I would then, according to Osteopathic 
procedure, go back to the centers along the spine, and I would look from the 
second to the seventh dorsal for a lesion, and if I did not find a lesion, I 
would still stimulate in that region. I might here instance a case that I have 
treated, a case of congestion of the lungs associated with heart trouble, where 
there was great difficulty of breathing, considerable pain accompanied by 



HOW TO TREAT THK SPINK. 35 

pallor and general debility, and there was every indication that the lungs 
were affected. And by giving not more that a minute's work in this region, 
from the second to the seventh dorsal on both sides, the patient sitting upon a 
stool, I, standing behind, raising the ribs and stimulating the centers, got a 
good effect. Sometimes in such a case you have to work quickly, and in 
some cases you will ±ind that it will not do to have the patient lie down. If 
I should, for instance, be treating this gentleman for stomach trouble, having 
in my examination and in my conversation with him found that he was so 
afflicted, I would look for some lesion along the spine in the region of the 
splanchnics, from the sixth dorsal down to the twelfth, especially the upper 
splanchnics for the stomach. And in that event, how would I go about to 
treat him? Simply by use of the points which I gave you in how to treat the 
spine. I would loosen the spine, and relieve any tension in the ligaments 
which I might find there, I would stimulate the muscles all along in this 
region, and work out any sore spots, and any contracted muscles. This con- 
tracture, or tightening of the muscles, I shall go into deeper in the course of 
a lecture or two. Thoroughly work along the spine, not too hard, using the 
flats of the fingers, which requires some strength in the muscles of the 
forearm. You need not be afraid of the patient, you need not be afraid to 
apply your treatment thoroughly, but you should use your judgment 
as to how long a treatment you should give. It is very hard to say anything 
as to the length of time of treatment; you will have to learn that for your- 
selves. Though in general a young Osteopath will treat a very long time, and 
an old operator will treat a much shorter time. If I should find that there was 
genital trouble or trouble with the pelvic viscera I shoulid naturally look 
along the centers in the lumbo-sacral region, and I would very likely find a 
lesion at the fifth lumbar, where I would find a soreness. In that case he 
would relax all the parts; I would bring the legs up against me and get a close 
application of the hand to the affected spot. Then holding in the sacro- 
iliac articulation, and, by lifting up against it allowing the weight to hang 
down from that point, I spring the pelvis and bring pressure upon these liga- 
ments, first on one side and then on the other, relaxing all the structures 
around the fifth lumbar, preparatory to reducing any slip which may be 
found there. Suppose there was not a slip there but simply a sore spot, my 
object would be then to work out the sore spot and thoroughly relax all of 
the tension. I will take up the setting of the slip of the innominate at another 
time. In the examination of a spine we may find a vertebra lateral at any 
point. Suppose, for instance, that the twelfth dorsal is slipped laterally, to- 
ward the right, we would very probably find that the sore spot was on the 
right side, as the sore spots in the muscles are as a rule on the side to which 
the spine is slipped, though it may be on the other side. I would first treat 
here at the twelfth dorsal, loosening the muscles about that point. How do I 
know when I have done enough of that? In general, when you find a more 
relaxed condition there. You cannot always at the first treatment relax 



36 HOW TO TREAT A SPINK. 

all the muscles; you will find cases very stubborn. I have treated cases 
where the muscles would relax under treatment but would contract again im- 
mediately. It will depend upon the case, but work a reasonable length of 
time and relax all parts if possible. After I have relaxed all the muscles 
tipon the right side about the twelfth dorsal, I pursue the same course on the 
left side; then go deeper than the muscles and stretch the ligaments. What 
is the condition of those ligaments when the spine is slipped in this way? I 
have shown you in a previous lecture that they are probably all upon a ten- 
sion, some forward and some backward. What we seek to do is to spring 
the spine up. By springing it you get the curve above and thus stretch the 
ligaments on this side, then turn the patient over and go through the same 
process upon the other side. Now, you will naturall}^ want to know how 
soon to attempt to reduce this slip of the vertebra. Most young Osteopaths 
when they find a dislocation want to put it back into place at once. You can 
only do that m rare cases. In a recent dislocation, if it is not very serious 
and does not set up a great amount of inflammation, it may be reduced at 
ouce. In an old dislocation 3^ou will have to work a considerable time to re- 
lax all these parts, throw new blood and nerve force there to endow them 
with new vitality which they have been lacking, and j^ou will have to learn 
by practice to work a sufficient length of time before attempting to set a 
vertebra. There are several methods of doing this. One of the best is to 
first exaggerate the condition. I would in this case have my patient upon a 
stool, the spine being tipped over toward the right, I bend the patient so as 
to exaggerate the condition, and thus bring tension upon the ligaments upon 
that side. I have before brought tension upon the other side and relaxed 
everything as far as possible, and by working the patient up and around holding 
against the spine of the vertebra, I in that way .slip it back into place. It does 
not always go back with a pop as nicely as could be, but you will perhaps have 
to pursue that method of treatment for a considerable length of time. But 
remember, please, that in setting a misplaced vertebra, in general the method 
is to exaggerate the condition, and that you then w^ork in just the opposite 
way and throw the curv.e in the opposite direction. 

Q. I do not understand the connection of the 5th nerve with the pneu- 
mogastric. • 

A. The pneumogstric supplying the stomach is affected directly from 
an exciting cause, the impulse passes along the pneumogastric going directly 
to the medulla, v/hich is the center for all of. these nerves which arise from the^ 
floor of the fourth ventrical, and then directly out over the 5thcranial nerve. It 
has been proved that an impulse can be sent from a nerve, through a center, 
and out over another nerve. 

Q. In referring to the back work we have gone over. I do not quite un- 
derstand why a click in the neck in the cervical region should be more serious 
than in the rest of the spine. 

A. Well, I so stated simply because it has been my experience that I 



THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 37 

could find these noises all along the spine when they mean nothing at all, the 
subject being perfectly healthy. While in the cervical region it seemed to me 
that there was always some slight break or contraction between the parts, like- 
ly enough to be serious. It showed that the blood supply had been cut off, 
thus diminishing the supply of lubricating material in the synovial membrane. 
I said that it was in general more serious, because my experience in practice 
seemed to bear out that point. 

Q. In the case of a lateral displacement of the atlas, would you exagger- 
ate the condition also? 

A. Yes, sir, as far as possible, but to set an atlas is quite h technical 
matter. I will take that in detail later. 

Q. Suppose there was a spinal curvature would you set it in the same 
way you would a single vertebra? 

A. In that case you would use the same general method, but you would 
begin at one definite point and try to set it, and then work upon the next ver- 
tebra, and so on. 



I^ECTURK VIII. 

At the last lecture I commenced to consider the osteopathic theory of work 
upon nerve centers. That is what I have called the subject in general, al- 
though it includes not only nerve centers, but nerve distribution and blood 
supply; how the osteopath works by external manipulation upon the surface of 
the body, gaining results internally. I first defined the terms stimulation and 
inhibition, and showed that while they are used in several senses, the osteo- 
path uses them in the usual sense. Our conclusion was that the osteopath was 
justly entitled to the use of these terms, stiniulate and inhibit nerve action, and 
that he works in the same manner as the physiologist when he is experimenting 
upon these nerves. That since the physiologist, gaining results which were 
similar to normal, reasons that he has therefore affected the nerves in a man- 
ner similar to normal, the osteopath should be allowed to say that, since he has 
gained results similar to normal, he has also affected the nerves in a normal 
manner. As to the term "desemsitize,'' I was not fully informed. I have 
since found that there is no such word, it is not in the Centur}' Dictionary, and 
I think I had better dispense with the use of it. However, we do the thing, 
whether we have the word the same or not. That is, taking away the sensi- 
tiveness from a nerve, or, the excitability, or its excited condition, is realh^ an 
inhibition of nerve force. Or it may amount to this, that we affect the con- 
ductivity of the nerve, and that is what I meant by the use of the word desens- 
itize. Since it was simply the improper use of the word, and not any confus- 
ion of points, I do not think we have to yield any point to the authorities 
there. We then are privileged to say that by external manipulation we have 
really stimulated or inhibited a nerve. If we have worked upon nerves and 
upon nerve centers in that way, we have produced certain results. The point 



38 THEORY OF OSTEOPATAIC WORK UPON NERVES AND CENTERS. 

that the physiologist works externally only sometimes, while we work outside 
altogether, does not make any difference with the argument, from the fact that 
we have as broad a range of results to show for our work as he has by both 
external work and work upon the exposed nerve. I think that my positio.n 
taken at that time was sound. 

I. Theory OF Osteopathic Work upon Centers. (Continued.) — 
Our operators agree that we secure direct results upon nerves by mechanical 
work, and while they do not all fully agree in all they say, I ga<^^her from the 
communications they have handed me that they all take that view of this mat- 
ter. For instance, Dr. McConnell says: "We affect internal nerve action by 
manipulation on the external parts of the body, by a general mechanical stim- 
ulation given to the nervous system." He says further, that we stimulate or 
inhibit sometimes but that he believes there is a general misuse of these terms, 
and that the results which may be expressed in these terms, are not often the 
result of some direct inhibiting or some direct stimulating work that we put 
upon an affected point. But we will bring that point up when I come to take 
up the further definition of these terms according to the osteopathic point of 
view. Dr. Harry Still says, "We inhibit by pressure or by holding, thus cut 
off nerve action, and break the force between the brain and the termination of 
the nerve." Dr. Harry also says that work outside upon the body, that is 
mechanical manipulation, produces a direct effect upon the nerves through pres- 
sure, thus affecting sympathetic life through its connection with the spinal 
nerves or their centers. He instanced the pneumogastric. Mrs. Still's reply 
shows that her idea is that we either directly or reflexly affect nerves or cen- 
ters by external manipultation. Dr. C. M. T. Hulett well illustrates in part 
the theory of our work as follows: "Pressure upon a nerve fibre will cause a 
break in the continuity of the semi-fluid axis cylinder; and if abnormality ex- 
ists, then the ever present tendency toward the normal will tend to restore 
normal conditions." I understand him to say that we may obtain that result 
by pressure upon a nerve, by external manipulation, which is the method we 
emplo3\ Dr. Hildreth and Dr. Charles Still both have something to say about 
this. I could not get their communications to-day, but will bring them later. 
Thus, as you see, there is considerable unanimity upon this point. I have not 
quoted all these parties have to say, but I shall quote from them to explain 
further points when we come to them. 

Remember, that this is not the only effect that we get upon nerve-centers 
or nerve life, this mere stimulation or inhibition, as we may be privileged to 
call it, but we do it and get important results. I leave this subject to consider 
a different point — there are other means at the Osteopath's command by 
which he may affect blood and nerve force. These means are important, but 
they are not what we style the most important means at our command* 
They are, however, important as being external, non-medicinal methods of 
reaching deep blood and nerve force. They are not distinctly Osteopathic, 
they are simply adjuncts to our work. One of these is the external application 



THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 39 

of heat or cold. I shall take up later, possibly, the subject of Hydrotherapeut- 
ics and kindred subjects. Green in his Pathology says, "It seems that vascu- 
lar dilation of deep organs may be produced reflexly by the application of stupes 
to the skin." They are invaluable, then, as adjuncts which the Osteopath 
may call to his aid if necessar}^: J may instance here that in case of inflamma- 
tion following some injury, you may find the parts so swollen as to make it im- 
possible for you to determine whether or not the parts are broken, or what the 
condition really is. You will frequently find that in such cases you must first 
reduce the swelling before you can apply your Osteopathic work. Not to say 
that we do not do it Osteopathically, for I believe that we do. In the rase of 
a swollen ankle we may by manipulation of the venous flow, loosening the struc- 
tures about the femoral vein, aid in taking down the swelling, but you will 
find that if such cases be of any great extent, you must bring in the application 
•of heat or cold. 

You will have to use fomentations and the application of dry heat very often 
and it is always advisable to have a good supply of hot water near you in case 
you have a patient where it is likely to be necessary. For instance, if you are 
treating a patient for some disorder and he is continually troubled with cold 
feet while lying in bed, you must use the application of heat, the idea being to 
get the patient as comfortable as possible, and to get a good distribution of 
blood throughout the system; also to prevent collateral hyperemia on account 
of having too little blood in one part. I think this is a good therapeutic hint 
for the Osteopath. You must pay attention to these details, or some such lit- 
tle thing may hinder to a considerable extent, the results you are trying to at- 
tain. The idea is to equalize the flow of blood throughout the body. The apt 
plication of cold is frequently useful, though we do not use it very often. I 
spoke of fomentations, that is a term applied to a hot, moist application. You 
will frequently find it useful to wring out a cloth in hot water, as hot as can be 
borne, and a pply it to parts, repeating the operation frequently. Tliat is a fom 
entation, while dry heat is applied by means of a hot water bag, or some such 
thing. Please bear in mind that these things are good in our practice. You 
may also get a vaso-motor effect by application of cold. Speaking of renal con- 
striction, Howell's Text Book says: '"The same effect (renal constriction) is 
easily produced by stimulating the skin, for example, by application of cold." 
Remember, please, that we as Osteopaths do not depend upon the use of these 
agents, but I call your attention to them as valuable, non-medicinal adjuncts to 
our practice, and also as supporting, by quotations from the standard text 
books, the contention of the Osteopath, that without medication the blood and 
nerve forces of life may be regulated to produce health. This is, too, valuable 
in our arguments with medical men. It all tends against the use of medication. 
I believe that the Osteopathic position may be still further strengthened by 
considering the effects produced, on the one hand, by the use of chemicals, 
drugs, or electric currents, and on the other hand by the Osteopath in his use 
of mechanical agents. In the first place, drugs and chemicals introduced into 
the system alter normal chemical conditions in which the nerve must be in order 



40 INJURIOUS EFFKCTS OF DRUGS AND KI.ECTRICITY. 

that its normal irritability may be preserved. In Howell's Text Book it is 
stated that the introduction of digitalis, ether, alcohol, water, etc., changes the 
condition of the irritability of the nerves. "From all these results it becomes 
evident that the normal irritability of nerves and muscles require that a certain 
chemical constitution be maintained, and that even a slight variation from this 
suffices to alter, and if continued, to destroy the irritability." Now, it is the 
physician, and not the Osteopath, who introduces these abnormal chemical 
conditions, thus destroying the normal irritability. I grant the force of the 
physician's argument when he says that he supplies these drugs for the pur- 
pose of supplying to the body some elements which are lacking, but I doubt 
whether that is the general method of medication. Where digitalis is given to 
retard the action of the heart it paralyzes the nerves and in that case certainly 
it was not given to supply the lack of some such constituent in the system. On 
the other hand, the Osteopath does not introduce any of these foreign sub- 
stances. He stimulates nature, and nature supplies from the food these vari- 
ous things which are needed to keep the normal chemical conditions under 
which a nerve or muscle is normally irritated. I further quote from Howell's 
Text Book to show the abnormal effects of electricity. ''Undoubtedl}^ chemi- 
cal and physical alterations may occur in nerves as the result of the passage of 
an electric current through them, and it would seem that the los^ of conductiv- 
ity which they show when subjected to strong currents is to be accounted for 
by such means." "The conductivity, like the irritabilitv of nerve and muscle 
is greatly influenced by anything which alters chemical constitution of active 
substance." Hence it must be that electricity, chemicals and drugs produce 
abnormal changes in nerve tissues. Therefore, I maintain that the Osteopath 
may secure better results from his manipulation than may the physician by med- 
ication, for, whereas the latter introduces into the system those agents which 
by their nature produce abnormal changes in nerve tissue, the Osteopath intro- 
duces no foreign matter. Moreover, he may, through his manipulation, attain 
results very similar to that produced by normal physical exercise of parts of 
the body. I might explain here the effect upon the nerves of an athlete in 
stooping and jumping. He may, for instance, stoop in such a way as that the 
thorax is bent upon the thighs, the knees touching the shoulders, and the scia- 
tica nerve is stretched, just as we stretch it in sciatica. There are normal ex- 
ercises, the results of which, if we can judge at all, are exactly similar to re- 
sults we obtain by giving a certam motion which is in our stock of remedies, 
we might say. Thus we reason concerning various contractions of muscles, 
motions of the back, bringing pressure upon the parts and thus keeping them 
stimulated up to the normal. I think that the similarity is readily seen between 
normal exercise, on the one hand, and the application of Osteopathic methods 
on the other; between the application of violent means such as the use of elec- 
tric currents, chemicals and drugs, and the application of normal exercise to 
the parts by Osteopathic manipulation. In the treatment of disease, normal 
exercise differs from Osteopathic treatment, in that the Osteopath has the pa- 



HOW TO TREAT A SPINK- 41 

tient passive in his hands and can work at will. These are not exercises upon 
his part, and it may be that he being ill would not be able to undergo such ex- 
ercises of his own free will. 

Remember, please, that the points which I have brought out have been ad- 
duced in favor of the argument that we may work externally upon the body, 
and thus stimulate or inhibit nerve force. But we do not consider that the 
most important part of our work. What we consider more important than that 
I shall take up when I come to describe what the Osteopath means in the second 
sense ig which he defines these terms, and this is but one part of the argument. 
I shall at the next lecture attempt to carry this line of thought a little further 
by quoting from authorities in support of the view that we may stimulate or in- 
hibit nerve force by external work. 

II. How To Treat the Spine. — (Continued. ) — I showed you at the last 
lecture how to treat a spine where a vertebra was displaced laterally. To-day I 
want to show 3^ou how to proceed when you find the spines separated. If by 
examination we find that there is a separation between the twelfth dorsal and 
first lumbar, how should we go about to rectify the conditions? How should I 
heal the breach? In such a case of course our method of reasoning is that 
there is a lack of tone here; there is a relaxation of the ligaments; we would 
rather expect that, though it is not necessarily so. And in that case, we would 
first go about to restore tone to all the parts here before proceeding further. I 
need not go over the same ground of explaining to you that you thus here 
reach the central distribution of the sympathetics all about this part which is 
lacking in tone, but in this case that would be the first step, and you might 
almost say the only step, although that is saying a little too much. The proba- 
bilities are we would not be able to put these vertebrea back into place at once, 
you cannot do that often. Simply thoroughly stimulate and loosen up the 
structures, and patiently await results, and you will gradually see those spines 
coming together. So that your best method, finally, is to stimulate, first on one 
side and then on the other, using the motions I have given you, bring about a 
strengthening of those parts. You need not work just between the twelfth 
dorsal and first lumbar, work a little higher and a little lower, and get a good 
effect all about the parts. Probably this motion of getting the elbows between 
the pelvis and shoulder, and spreading while you have the fingers on the oppo- 
site side of the spines, and springing up as you spread, will obtain good re- 
suits. 

Q. If the three upper lumbar and two lower dorsal vertebrx are posterior, 
in that case would springing it in that way tend to bring it back to the proper 
position in time? 

A. Yes, in part. I shall take that up when I consider variations from 
normal curves; that would be a part of the method, however. 

Probably I would have the patient sit up on a stool in case they are separ- 
ated. You can separate them a little more. Going upon the principle of exag- 
gerating the defect, spread them a little more, thus allowing a stretch and a 



42 THKORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. ^ 

recoil, which naturally follows, and in that way throw new life to the part, and 
then we seek simply to push them together. You can lift up and push down 
and get the parts approximated in that way. 

Q. In the lecture reference is made to paralysis without loss of sensation, 
do we ever have loss of motion without sensation ? 

A. Yes, frequently. You will find that in your practice, loss of motion 
without loss of sensation. 

Q. Do we have loss of sensation without loss of motion ? 

A. Yes, sir, you may have either. 

Q. Is epilepsy caused by displacement of the vertebrae ? 

A. Very frequently caused by displacement of one of the upper cervical 
vertebrae; we find it so in our practice. 

Q. You were speaking of stimulating the circulation in the feet by the 
application of dry heat, is there any practical osteopathic treatment for cold 
feet? 

A. Yes, but in case you have a severe case of cold feet it would be very 
difficult to at once throw enough blood to those feet to warm them in case the 
patient were very sick. You could not adopt measures strong enough on ac- 
count of the general debilit}^ of the patient. But I will say this, that condition 
yields gradually, as do a great many other things to treatment, and people I have 
known who had been troubled with cold feet for years would find, after a course 
of treatment of a month or more, that they were no longer troubled in that 
way, that the general circulation was better than it had been for years. 



LECTURE IX. 

At the last lecture I considered further the theory of Osteopathic work up- 
on centers, and briefly, to recapitulate, these were the points I took up: First, 
that our operators agreed in the use of these terms, stimulation and inhibition 
in general, although there is some difference in the reservations they make. 
I also quoted from different ones of our operators to show their opinions in the 
matter. I then called your attention to the fact that that was not the only 
way, nor yet the most important way in which we considered these terms; that 
there are other means by which the Osteopath may command deep nerve force 
and blood flow, by the application of heat and cold, which, while not being dis- 
tinctly Osteopathic methods, are yet at the Osteopath's command, and serve to 
strengthen our argument that these forces of life can be reached from the ex- 
ternal surface by proper methods, without medication. I quoted from author- 
ities to substantiate these points. In general, the application of heat is better 
than cold. I compared the effects produced upon the nerves by chemicals and 
by electric currents, as producing a certain change in a nerve, producing a 
certain change in the chemical conditions under which a nerve must be normal- 
ly in order to be normally irritable, and so I reasoned that the Osteopath's 
practice was the more rational, since he does not introduce these foreign things 



THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS, 43 

-into the system. Further, I called your attention to the similarity of the ef- 
fects of the Osteopathic work upon the body, and the effects on the body of 
normal exercise; the difference being, in part, that your patient being sick is 
not able to undergo these physical exercises, while in your hands he is passive, 
:and these effects may be given without the fatigue which would accompany 
his own exertion. Today I continue the consideration of this subject. 

I. Theory of Osteopathic Work Upon Nerve Centers. — (Contin- 
ued.) — The arguments advanced in the last lecture may be strengthened by 
quotations from standard text books. Having shown that the Osteopath, by 
means peculiar to his system of treatment, accomplishes results through stimu- 
lation and inhibition of nerve action that are worthy of being considered nor- 
mal results as those accomplished by physiologists through methods pursued 
b}^ them in experimentation; having shown, further, that the Osteopath ac- 
complishes such normal results in every part of the body, there being cases up- 
on record to prove that that is the fact, it therefore at once becomes apparent 
that the whole field of nerve-force, controlling directly or indirectly every mo- 
tion or function of life, lies open to the Osteopath; that wherever there lies a 
nerve of the body capable of stimulation or inhibition, it is his to command, 
providing only that such nerve may be reached by Osteopathic methods, either 
directly, as through pressure or indirectly, as through the blood supply. For 
stimulation is stimulation, and inhibition is inhibition. It makes no difference 
in fact. I will grant that there may be a difference of degree of stimulation or 
of inhibition. However, having shown that the Osteopath stimulates or inhib- 
its just as really as does the physiologist, the question of the degree of stimula- 
tion becomes a secondary one, and one relative only to the point in view. Re- 
sults obtained in the cure of diseases in every part of the body, and of almost 
-every known form of cureable disease, show conclusively that the Osteopath 
has really stimulated or inhibited nerve force according to the end which he 
has in view. It would be no argument to say to an operator that he could not 
stimulate enough to cause a man to jump over a table. His fitting reply 
would be that such was not the end in view, that the end in view, perhaps, 
was the stimulation of a flagging circulation to restore it to its normal force 
and activit}^ and that he very readily accomplished that result. So degree of 
stimulation really makes but little difference to us, granted that we have gain- 
ed results. I belive that there is no nerve of the body that the Osteopath may 
not reach by proper manipulation, either directly or indirectly, by pressure, by 
correction of lesion, by removal of obstruction, or by control of blood suppl3\ 
What that fully means we shall see as the subject is developed. 

Now, for further argument, in view of the above facts, it is interesting to 
note the following quotations from authorities as confirmation of the claims of 
the Osteopath, since the authorities have made use of such means as has the 
Osteopath to produce effects upon nerve action. Speaking of an experiment 
upon the ear of a rabbit. Kirk says: "Division of the cervical sympathetic 
produces an increased redness of the side of the head, and looking at the ear 



44 THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 

the central artery with its branches is seen to dilate and become larger, and 
many similar branches, not previously visible, come into view. The dilatation 
following section can be demonstrated in a very simple way, by pressing the 
nail of one finger upon the nerve where it lies by the side of the central artery 
of the ear." So that you see that the application of the external force, in 
Kirk's opinion, is equal to section of the nerve. Again, from Green's Pathol- 
ogy; speaking of the vaso-tonic action of the sympathetics, the author says: 
"The reflex process is generallv due to stimulation of sensory nerves, the di- 
minuation in tonus produced being more or less accurately confined to the re- 
region supplied by the nerve. Fricti n and slight irritants, in the early stages 
of their action, produce hyperemia in this way." Thus you have another il- 
lustration of the application of an external mechanical agent, that is friction. 
You thus set up a reflex action. I shall consider that further when I apply 
this argument to work on the centers; I quote further from Howell's text 
book, "A sudden pull, piach, twitch, or cut excites a nerve or muscle. All 
have experienced the effect of mechanical stimulation of a sensory nerve through 
accidental pressure on the ulnar nerve where it passes over the elbow, ''the 
crazy bone." Speaking of their ir^itabilit3^ the same text book says: 'Stretch- 
ing a nerve acts in a similar wa}', for this is also a form of pressure, as Valen- 
tine says, the stretchino; causes the outer sheatli to compress the m^'clin, and 
this in turn to compress the axis cylinder." This is a common mode of our 
treatment, as we flex the limb upon the thorax strongly in order to stretch the 
sciatic nerve, that being a part of the treatment, and there are certain move- 
ments we adopt to stretch the brachial plexus in nervous aft'ections of the arm. 
I quote further from the same source: "A reflex fall in blood pressure is also 
produced b\' a mechanical siimulation of the nerve endings in the muscle." 
This, then, was a mechanical means, and the fact that we can thus work on 
nerve endings, which of course occur all over the body in the muscles, thus 
gives to us a fruitful field for the application of external manipulation, A 
little further, Howell's text book says: "Both the sym.pathetic and vagus 
nerve fibres have their influence over the heart, decreased by cold and increased 
by heat." Now, having made these quotations, allow me to call your atten- 
tion again to the fact that I have quoted thus fully for the purpose of showing, 
out of the mouths of the authorities, the fact that the blood and nerve supply 
may be regulated b}^ external manipulation. I have quoted them for the sake 
of the argument, not for the purpose of giving license to our practice, because 
w^e demand license only on the results which we have obtained. Nor by the 
above quotations which I have made do I intend to yield a point and say that 
the Osteopath can obtain only such results upon nerve action as is attained by 
physiologists by external manipulation, because I believe that I have shown 
that the conclusion is fair that the Osteopath can, by his method, affect any 
nerve in the body. Hence, I shall deem it competent to give you vaso-motor 
centers, etc., with the understanding that the Osteopath has a right to regard 
all such as legitimate objects of treatment, as his facts revert to in argument. 



HOW TO TREAT A SPINE. 45 

and as his equipment for work in the eradication of disease. As I said, the 
more important part of how the Osteopath stimulates or inhibits is still to 
come, and I shall pursue this subject for a lecture or two further. 

How TO Treat a Spine. — (Continued.) — At the last lecture I attempted 
to show you how we reason and work in case the spines were seper^ted. In 
to-day's lecture I wish to take up the question of how we would work in case 
the spines were approximated. That is, how would we separate those spines?' 
If, in passing your fingers down the spine you come to some place where the 
spines of the vertebrae are too close together, and this is a verj^ common lesion, 
your reasoning in that case would be that there had been some injury, at that 
point, to the spine, perhaps a sudden jerk or a twist, which had resulted in ir- 
ritation; too much life in the form of nerve and blood force, had been thrown 
there, resulting in a thickening of these ligaments, thus contracting and bind- 
ing those parts together. When you come to study pathology you will find 
that an}' irritation sufficient to set up an inflammation is very likely to be follow- 
lowed by the formation of new connective tissue or the thickening of the exist- 
ing tissues. Thus, 3'ou will find that reasoning that too much force has been 
directed to these parts, our work is to overcome the results of such misdirection 
of energy. We set about to do it largely by the same manipulation as we 
would adopt in the case of approxicnating spines, at least in the first stages. 
We would loosen up all the parts, very likely you would find a tension in the 
ligaments at these points as well as in the muscles. Having loosened up all 
the muscles, we would then spring the spines upward, getting this stretching 
motion that I have before described. I would work with sufficient force, ac- 
cording to the size of the patient, to stimulate these parts and set up what 
would seem to be as free action as possible. You can then operate by flexing 
the knees up against vour own body, and get considerable purchase on such a 
point as that, and while it is rather a siraiued position for the operator and I 
cannot say that it is always comfortable for the patient, it is a very good way 
to work, because you have your patient in such a shape that you will hardly 
•injure him by lifting him, as I have done, fairly off of the table. By this 
method you may use considerable force, but of course you must not be rough. 

I spoke to you about a smooth spine, meaning a spinal column which 
showed all along it that the spines were approximated and bound down close- 
together. Now, you have a variable condition there, it ma}' be so bound to- 
gether that it will be quite rigid, or it may be capable of considerable motion, 
but having this peculiar smooth feeling all the way, so as to lead you to sus- 
pect .some trouble. I have had a number of cases of that kind, where the whole 
spine was in that condition, or some one particular part of it, and almost invar 
iably there was a history of some strain or jolting or twisting that had set up 
an irritation along the spinal column, and had resulted in a tightening of the 
ligaments, which has resulted iti the approximation of the vertebrae. In such 
a case the manipulation would be largely as I have shown. I would simply 
loosen up first the muscles along the spine, remembering to work against the 



46 TREATMENT OF THE SPINE. 

grain of the muscle, of course working on both sides. A good way to do that 
by the motion I gave you with the patient on his face; you can exert consider- 
able force, and as he is relaxed you can loosen muscles very nicely. Having 
done that I would proceed to spring the spine along its various parts. By flex- 
ing the knees you can spring the spine in the lumbar region, and by using the 
arm as a lever you can spring the spine in the upper region. Of course it is 
rather difficult to spring the spines between the shoulders; one good way to 
work there is to get the elbow against you, and work along the spine by hold- 
ing and stretching your object, of course, being to loosen all of these ligaments 
and to relax whatever is holding the spines together. 

As to the misdirection of energy in a part resulting in their being bound 
together, it may of course be entirely possible that at this present time there is 
not a misdirection of energy, but there has been, w^hether past or present it 
does not make a great deal of difference. The misdirected energy may have 
acted for a time sufficient to thicken and perhaps to contract the ligaments, and 
then have been diffused to other parts of the body, so that this may be an old 
result without there being at present any misdirected energy or life at the point 
of lesion. 

I would then have the patient on his back and would stretch the lower 
part of his spine by taking one of his limbs and my assistant the other, and 
workmg both limbs up toward the chest, thus getting a purchase on the lower 
part of the spine. You are not very likely to hurt the patient but you must 
be careful because different people are different in that respect, and 3^ou may 
do considerable hurting, if not actual damage, in that way. Again, if you 
have such a case you want to bring traction on the spine as much as possible; 
and it is a very good way also to take hold of the patient by the occipital pro- 
tuberance and the inferior maxillary so as to exert traction enough there to 
pull the patient along the table. You are not likely to hurt the patient with 
that degree of force, unless it be a delicate lady. Remember that you have 
already sprung the spine by working all along on each side. One precaution 
you must observe when 3^ou have the neck extended in this way, remember 
that the neck is less supported than the other parts of the spine, and if you 
should twist at that time you might cause a dislocation, the articular processes 
might slip out of place, so it is advisable not to attempt to twist when you have 
it extended. If you wish to twist the neck, do it when the spine is not under 
traction. In order to be thorough the treatment must be applied to the whole 
length of the spine, and when 3^ou had the patient upon his face you w^ould 
have loosened up the muscles along the lower regions of the spine, the sacrum 
and coccyx. You ma}^ get considerable force by putting the knee against the 
sacro-iliac articulation and springing the pelvis. You must relax all the liga- 
ments, you should loosen up all about it as well as further above. Remember 
that your work has been simply to loosen up parts which through misdirected 
energy have been drawn together. Of course, when you have such a condition 
you may haye almost any result, that is, results affecting the bodj^ through the 



TREATMENT OF THE SPINE. 47 

nerves in almost any way. As a general rule I think you will find that the 
results may not be marked, but may be general, and you may have a case of 
general malnutrition, or neurasthenia, or something of that kind. 

I would next set the patient on a stool and use the motion I showed you 
at the last lecture, then you can get hold along the spine, generally it is better 
to work from the bottom up, though it does not make much difference; I hold 
there, bend back a little and exert traction as I ascend the column. That is a 
very good way. You may produce the same result and I think get a little 
better stretching motion by taking a turn as you work, you would be more 
likely then to stretch all the ligaments about the vertebrae. 

In case you have a spine misplaced anteriorly, you will have something 
which is rather difficult to deal with. In such a case you must depend largely 
upon the effects of the general strengthening which you give to the parts to 
w..rk the spine out into its normal position, as you must in other cases also. 
But when you have the spine anterior it is very difficult to get hold of the ver- 
tebra or to influence it. However, Mrs. Dr. Patterson makes a point of get- 
ting hold of the spine as much as possible and working at it.. In case of dislo- 
cations of cervical vertebrae it is a good point to examine internally, and when 
the dislocation is considerable you may find a protrusion into the pharynx. In 
such a case you would use not only the method I told you of, trying to reach 
the spine, but would thoroughly manipulate every point about it, and would 
spring it each way. You might also get the patient down and go through the 
lifting motion. There is one other method that I think would be helpful, that 
is, your spine being anterior, and going upon the principle that we sometimes 
adopt, of exaggerating the defect, you could bend the patient backward, and 
by placing the knee in the back and raising the arms above the head (you must 
be careful with this motion) that would exaggerate the defect, it would loosen 
the ligaments along the anterior part of the spine which are already stretched, 
and which you wish to stretch a little more in order to get the effect of the 
recoil, and then by relaxing and allowing the patient to drop forward again^ 
you get the recoil. Then there is another point which I think will be helpful 
to you, it is practically the same as I showed you, as you work along the spine, 
the idea is that you get the bodies of the vertebrae to move one upon the other. 
Mr. Bolles first spoke of this to me. You get the same result as when you 
move your body by working your feet along the floor. I think you may very 
readily get such a result by working the bodies of the vertebrae one against the 
other. 

In case there is a spine posteriorly, what would you do? I take up these 
points in detail as I went over them in examination of the spine, although the 
method of treatment is largely the same. If the spine is posterior you would 
bend your patient forward, simply to exaggerate the defect and then you could, 
turn him to either side and get the effect of the recoil by pushing him back- 
ward. Of course in such case you must be careful not to use too much force.- 
and not to strain the parts beyond what they would normally stand. 



48 TREATMENT OF THE SPINE. 

In examination of the spine I spoke to you concerning the ligamentum 
-nuchse and the importance it sometimes bears in our treatment of the spine, 
mentioning the fact that I have often found cases of headace which would yield 
to treatment only when the ligamentum nuchae was relaxed. By carefully ex- 
amining along the furrow just below the occipital protuberance 3^ou may find 
that the ligament is tense, you ma^' find that it presents a firm 
■resistance to the hand; the patient can also feel it by stretching the 
head forward; he will feel that the ligament is tense. Naturally, 
in projecting the head forward, one should not feel a sense as of a check rein 
there, but in case of cold I have frequently found it distinctly upon myself, 
have felt a sense of tightness along the region of the neck, and by examination 
with the hand there I came to the conclusion that there was no other reason 
for the trouble than that the ligament was tense, and I think that was really 
the fact. The way to stretch that ligament is ver}^ simple. I usuall}^ just 
.flex the head directh^ upon the thorax, admonishing the patient to lie with his 
weight down, to let his weight fall against mj^ bands, and I raise the head with 
sufficient force to raise the shoulders off the table. That would be a good 
movement to adopt in stretching of the spine when the whole spine was 
-smooth or tense. That, together with flexing of the two knees against the 
shoulders would make a very good extension movement. In such a case of 
tightening of the spine it is a good idea to advise your patient to hang himself, 
not literally, but to catch hold of his closet shelf or the top of the door jam and 
'bring the weight of his body upon his arm muscles. That would tend to relax 
the spine, and it is a very good way to relax the lumbar portion of the spine, 
as it is not so much supported bj^ attachment to the shoulders as the upper 
parts of the back, from the twelfth dorsal up. I have often heard Dr. Harry 
Still advise some such stretching motion. 

Q. When you have relaxed the structures along a smooth spine, would 
•you give the stretching treatment at the same treatment? 

A. Yes, sir. 

0. In the case of a vertebra being anterior, placing the knee on the 
spine, would you put it above or below the vertebra that was anterior? 

A. Well, generally just about that point. You of course regulate your 
force, and I do not think you are in any danger of pushing it forward, but the 
general idea there is not to bring pressure upon that point, so much as to give 
a fulcrum against which to work, and letting the general tendency of the for- 
ward motion of the spine do the work. 

Q, Would stretching the ligamentum nuchae have a tendency to get pos- 
terior curvature out between the shoulders? 

A. Partly so, though we do not usually pursue that method for that par- 
ticular thing. It would help. 

Q. In stretching the ligamentum nuchae forward, is there any danger of 
acting upon the nerves that go to the stomach? 

A. I have never found any trouble in that way; I hardly think there 



THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 49 

would be, unless in case of defect, as you thus stretch the whole spine, you 
tnight get an effect upon the splanchnics. 

Q. In case of anterior displacement of the 4th cervical, would the stretch- 
ing of the ligamentum nuchae have a tendency to draw it out? 

A. It would not have much of a tendency to do that; it is true there are 
slips that run down to those vertebrae, but you would hardly get enough ten- 
sion by those slips to bring tension upon the vertebrae. 

Q. In separation of the spines there is a weakness of the ligaments and 
in approximation there is tenseness, and our treatment seems to be very much 
alike, how do we know that the same treatment will cause an opposite effect? 

A. That is a good question. Of course there is a certain lesion, in one 
case there is an approximation, in the other a separation; there would be no 
trouble in diagnosis. You must not misunderstand the use of the terms, too 
much or too little life directed to a point. That is true, but there may be ex- 
ceptions, in case of a sudden wrench or jerking of the vertebrae apart, which 
frequently happens, there would not necessarily be a relaxation of the liga- 
ments; but that is a general method of reasoning, I have mentioned it for the 
sake of its importance. But as to your question how we could get the different 
effect by practically the same treatment, it simply amounts to this: that in 
each case you are trying to stimulate parts; in one where there is a tightening 
of the ligaments you use a stretching motion to draw them apart; in the next 
case where they are separated, granting there is too little life there, you wish 
to stimulate them by stretching them, and getting the benefit of the recoil and 
throwing more life to the part. 



LECTURE X. 

At the last lecture I brought out the point that from the preceding argu- 
ments it became apparent that the whole field of nerve force was open to the 
Osteopath, and that the probability was that there was no nerve in the bod}^ 
which he could not affect either directly or indirectly, thus opening up to him 
the whole field of nerve life. That the question of degree of stimulation was 
not an important one, since the Osteopath manifesth^ could stimulate or in- 
hibit, that is, could affect the nerve in such a way as to gain the desired end. 
I then quoted from certain texts, one from Kirk concerning an experiment up- 
on a rabbit's ear, section of the nerve followed by vaso- dilatation of the ear, 
he showing that the same thing could be done by pressure of the thumb nail 
upon the nerve; also a quotation from Greene concerning the reflex process 
being generally due to stimulation, which might be applied mechanically. The 
general idea of those quotations being to show that we could from the books 
get authority for what we have been arguing; that that did not limit us, since 
we have shown that we can get results in every part of the body; hence, we 
are not limited to the same kind of experiments as the physiologist when he 
;gains results by external experimentation, but since we can reach the whole 



50 THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS- 

body, we are privileged to say that we can stimulale the nerves in any part of" 
the body. Today we continue the same subject. 

I. Theory OF Osteopathic Worr Upon Centers. (Continued.) — 
The subject grows under my pen, and I do not know but what there will be 
several more lectures before we shall have concluded the subject. I have been 
calling 3^0ur attention to the fact that the view I gave you of mere stimulation 
or inhibition, direct or indirect, was not the important thing that the Osteo- 
path considers when working upon nerve centers. I have reserved that until 
now, calling it the second view taken by the Osteopath in regard to stimulation 
or inhibition of nerve action. This is that by the removal of lesion, some, ob- 
struction which has been preventing the direct flow of the blood or nerve force,, 
the tendency toward the normal is left free to act. And that is the kernel of 
our work, I believe. Not that we do not do the other things, but I wish to 
lay stress upon the fact you must look for lesions, and having found the lesion. 
and having removed it, you do not have to stop to consider whether it i*^ stim- 
ulation or inhibition that you must produce. After you have the lesion re- 
moved you have the ever present tendency toward the normal to regulate the- 
activity, and leave Nature to do the work. In case the lesion or obstruction, 
had been such as to inhibit nerve action or lessen the conductivity of the 
nerves, and thus prevent the proper conduction of nerve impulses, and you re- 
move that lesion, the result would practically be stimulation. For instance,, 
you might have had the tightening of the spine along the region of the upper 
splanchnics resulting in an impingement upon the branches connecting with, 
the sympathetics in that region, thus interfering with the nerve force to the 
solar plexus and to the stomach. The result might be a case of dyspepsia. 
There you have an inhibition of nerve force; you have not enough life to digest 
the food put into the stomach. When you have removed that obstruction, 
what have you done? You have taken away that obstruction, you have left 
Nature free to act, and she will go about stimulating and renewing the nerve 
force at that point. What you did was to correct the lesion, you did not stim- 
ulate nor inhibit, you did not care about that particular point in your treat- 
ment. On the other hand, if the lesion has been just sufficient to bring irrita- 
tion upon the nerve and to keep it stimulated to an abnormal degree of activity, 
that is what you would call abnormal stimulation of the nerve, then by removal 
of the lesion, you would obtain the result of inhibition. That is, you would 
remove the irritation, leaving free the tendency toward the normal to act, and 
the result of Nature's work would be a quieting of the nerve, and thus a curev 
You have simply corrected the lesion. A very familiar example of snch a con- 
dition is in female troubles; you may have a uterine tumor affecting the hypo- 
gastric plexus, disturbing the kidneys If that tumor is taken down or re- 
moved the result would be stimulation, but you have simply corrected the 
lesion. This is the most important thing that the operator does; he removes 
lesions in the great majority of cases. The lesion may be lack of nutrition, 
that is, of blood-supply to the nerve; it may be a displacement of some import- 



THKORY OF OSTKOPA'THIC WORK UPON NERVKS AND CENTERS. 5 1 

ant part, bringing direct pressure upon the nerve. No matter what the lesion 
be, the Osteopath's knowledge of anatomy, and his trained sense of touch en- 
able him to discover abnormalities in anatomy and gives him his peculiar adapt- 
ability for the treatment of disease. I do not know that it is because we are any 
wiser than physicians, because I do not think we are, but it is because our sys-- 
tem differs from others radically; we look at disease from an entirely different 
standpoint. I hope later to take up that subject, the different systems and 
schools of medicine and their modus operandi. The result of our method is 
that we make a correct diagnosis of the case. You remember that Dr. Hil^ 
dreth put especial emphasis upon that; stating that the strong point of Oste- 
opathy is that we make a correct diagnosis; that we diagnose from a physical 
standpoint. In the great majority of cases the Osteopath diagnoses and re- 
moves some displacement, hence the importance of looking for the lesion in 
every case. To illustrate the difference between the position taken by our 
medical friends and our position: When I was visiting at home about a year 
ago, a young man called on me to be examined. It was the same old story of 
a dislocated hip, the leg being shorter than it ought to be by about an inch, 
and there being a tumor upon the side of the sacrum, made of course by the 
protrusion of the head of the femur. Now, he told me how the doctor had ex- 
amined him, simply by setting him on the other side of the room and question- 
ing him. That illustrates the difference in our methods. You will find that in 
your practice, there will not be a month pass but that you will find some 
similar case where the doctor has simply sat across the room and questioned 
the patient and has not made a thorough physical diagnosis. So if you will 
take the trouble and will (thoroughly acquaint yourself with texts on 
physical diagnosis, I think you will be amply repaid . 

By quoting from the operators in the building I wish to show that they 
believe that we reach centers and affect nerve force directly by the removal of 
lesions. I quote first from Dr. Hildreth: "In the first place, where a lesion 
may exist, by manipulation or rather by Osteopathic treatment you reduce the 
lesion, you re-establish a natural circulation, and in so doing you carry away 
any obstruction which may exist. You thus remove the obstruction to nerve 
centers. If there be a contracted condition of muscles, the dislocation of a 
vertebrae, or recent injury of tissues sometimes without dislocations, all these 
conditions may produce disease of the different nerve centers of the spine, and 
the effect of Osteopathic treatment in all these conditions is to help to re-estab- 
lish a natural nerve current, thereby restoring a normal condition of circula- 
tion, thus relieving all tensions on nerve centers. With this done thoroughly 
health cannot help but follow, for a healthy condition is a natural condition. 
Thus you see that Dr. Hildreth's idea is that the Osteopath adjusts abnormal- 
ities existing in the anatomy and simply leaves Nature free to restore a condi- 
tion of health. I wish to add this to what Dr. Hildreth has said: In some 
few cases you will find that all that is necassary to do is to stimulate the blood 
supply. The blood supply acting through a longer or shorter time removes 



52 THKORY OF OSTKOPATHIC WORK UPON NKRVKS AND CBNTE^RS. 

the lesion. What you have done in that case was not to remove the lesion, 
but you have stimulated the blood supply, which you have done through direct 
manipulation of the nerves controlling circulation. In that case the matter is 
reversed, the cart before the horse. You have to do this in the case of rheu- 
matism, where there are deposits in articulations. That, of course, is not a 
primary lesion, but it is a lesion. You must stimulate the blood flow so that it 
will absorb those deposits. We sometimes absorb small abscesses, or thicken- 
ing of parts in that way. You first remove the primary lesion, and then the 
secondary result has been to remove the other lesion. Of course we cannot 
always bring fac:is down to fit theories. I quote further from Dr. McConnell: 
"Our Osteopathic work is largely performed in correcting lesions involving 
nerves or nerve centers, also in correction of the lesions of the arterial, venous, 
lymphatic, and other fluids that bear a relation to such centers. In some few 
cases we simply correct lesions of nerves passing from or to the brain, or the 
cord, or sympathetic chain, or to the organ affected.'' Thus you see that Dr. 
McConnell's idea is that we work upon nerve centers, but that we do it by 
affecting either the fluids of life or the nerve forces of life. His idea being, of 
course, that we remove lesions, as his words impl5^ He also says that we 
sometimes work to restore organic activity or health by removing a lesion from 
a nerve, that is, independent of its center. That is, you may have a pressure 
upon a nerve, and removal of that lesion may not affect the center. From Dr. 
Turner Hulett I quote as follows: "Pressure upon a nerve fiber would cause 
a break in the continuity of the semi-fluid axis cylinder and the damming back 
of its current upon its center of supply. If any abnormality exists, then the 
ever present tendency toward the normal will tend to restore normal conditions. 
If the previous condition was abnormal stimulation, then inhibition or desensi- 
tization was accomplished; if it was sub-normal, then stimulation was accom- 
plished." This expresses very nicely what I have tried to show you, that 
whether you stimulate or inhibit depends upon the nature of the lesion that 
you remove. I might quote further from other operators, but lack of space 
forbids. I hope this subject is not growing threadbare. We hear a great deal 
about removal of lesions and stimulations, etc., and perhaps you get a little 
tired of it, but I think it important to get these things correlated in some defi- 
nite system of argument, so that we may have together the points relative to 
Osteopathy. ^ 

We have thus answered two of three questions propounded. First, what 
does the Osteopath mean when he says he "stimulates or inhibits?" Second, 
how does he affect internal life by manipulation upon the outside of the body? 
and we have partly answered the third, How does he affect centers? I have 
taken this up in detail because these questions are some of the most bothersome 
to the young Osteopath, and to the older ones as well, sometimes, and if you 
are prepared with arguments, you may retain many a patient by explaining 
these things to him in a logical way. 

Now, as to how we work upon centers, I wish to carry the argument a lit- 



THKORY OF OSTEOPATHIC WORK UPON NKRVK CENTERS. 53 

tie further. From what I have quoted from Doctors Hildreth, Hulett and Mc- 
Connell you see that they believe that we work upon centers first, by the re- 
moval of lesions or obstructions, and second, by direct stimulation, and I think 
there is no doubt but that we do affect centers. What I have quoted from 
them was given to me in reply to the question, "How do you affect centers in 
the spine?" I wish to call your attention to the fact that the conclusion is in- 
evitable from what has been said that we must reach nerve centers, not simply 
nerves alone. Certain facts which we show bear out this conclusion. Speak- 
ing of the sympathy between the area that is supplied by the 5th nerve and the 
area which is supplied by the vagus nerve, Dr. Jacobson, Dr. Hilton's editor, 
says: "This s^-mpathy is an example of a reflected sensation in which the 
connection between the nerves concerned takes place in the nervous center. ' ' 
Thus you have your effect running up one nerve through a- brain center and 
down another nerve. Now, if you have a lesion affecting the periphery of one 
of these nerves and you remove that lesion, you have naturally affected the 
center in ;he brain, there is no doubt whatever of that. He gives a case of 
obstinate vomiting in a child, which was cured by simply removing from each 
ear of the child a bean which had been introduced in play. There was a stim- 
ulation of the 5th nerve, the impulse must have gone through the floor of the 
4th ventricle out over the vagus to the stomach. Of course there is a connec- 
tion of the 5th nerve and vagus by means of the sympathetic, but it is indirect, 
and it is probable that the brain center was the connecting link, as Dr. Jacob- 
son says. 

Again, we must reach nerve centers, because by the very definition of 
reflex action, which we know is an action caused by an impulse sent back 
along a nerve to a center and then out. From its very definition, if we cause 
reflex action by manipulation, the inference is inevitable that we affect centers. 
That we may do this is shown in performing the experiment for tendon reflex. 
This is very easily done be crossing the leg at about right angles and then get- 
ting the reflex by tapping the tendon. That is a reflex action. You have sent 
the impulse from the nerve endings in the muscle back to the center in the cord 
which governs the nerve supply of the muscles of the limb, the gluteal muscles 
have contracted and thrown the limb out. So you have affected the center. 
Again, every time we set up a vaso motor action we have probably acted upon 
a center. Howell's Text Book says that vaso-motor nerves can be excited re- 
flexly by afferent impulses conveyed either from the blood vessels themselves, 
or from end organs of sensory nerves in general. Of course the thing is proven 
the moment you show that vaso-motor actions are reflex actions. I have 
instanced here the bleeding of the nose, epistaxis, stopped by irritating the 
superior cervical ganglion of the sympathetic; simple stimulation of the neck 
at that point has stopped bleeding of the nose. The conclusion is that you 
have acted through a nerve center. 



54 TREATMENT OF THE SPINE- 

I have shown first, that we affect a nerve and its area of distribution direct- 
ly, instancing the result of pressure of the ulnar nerve where it crosses the 
"crazy bone" so-called, thus you have numbness in the hand; you have affect- 
ed that nerve in its area of distribution directly, not through a center. Second, 
we affect a center by removal of a lesion, the beans in the ear being the exam- 
ple cited. And third, we affect a center without removal of lesion, but by the 
effect upon the nerve, as in the ear of the rabbit, there was no lesion removed 
when we press on the nerve, we acted on the nerve back through the center 
and got our effect. Those are at least the three different ways in which we 
may affect nerve action. 

II. How TO Treat A Spine. (Continued.) I have examined this gentle- 
man and find the curves of his spine are not normal. What I wish to do is to 
work inward this curve in the lumbar region, and wish to make more pro- 
nounced this curve in the upper dorsal region, because it is flattened, while 
the other is drawn out a little posteriorly, thus you have a somewhat straight 
spine. At the risk of being tiresome I bring these points up in detail as I took 
them up in examination of the spine. I think 3'ou know what to do here as 
well as I; I have shown you how to approximate or separate vertebrae, and 
you would treat by a combination of the methods I have shown you; the relax- 
ation treatment with the patient on his face, or springing of the spine all along 
the relaxation of the ligaments and muscles, and thus of the blood and nerve 
force to those parts By a combination of those treatments you would tend to 
strengthen the normal curves. You would thus remove the lesion, which 
would be the tightening or tension that had thrown them out of their normal 
curves, and would leave nature free to act. You cannot quickly replace those 
vertebrae in their normal curves; you must strengthen gradually and build up 
the spine in order that it may take its normal position. This tendency toward 
the normal is of great use to the Osteopath. 

You may find th^ coccyx in almost any position, either anterior or to one 
side. What you must do is to give a local treatment. The method of digital 
treatment is to first place the finger along the natural curve of the coccyx, and 
by working from side to side free all the ligaments and tissues thereabout. In 
this way you loosen everything over the foramina where the nerves emerge,, 
or any binding down which may have occured over the nerves directly. You 
have inserted the finger and have turned it so that you have worked every side; 
you must thoroughly relax before attempting to reset. This must be done not 
only internally, but you must thoroughly relax all the muscles externally. It 
will take some time, but you can at each time you treat the patient bend the 
coccyx toward its proper position. Of course there are lesions of the coccyx 
which may be set immediately^ In general, it is recent dislocations that yield 
thus quickly to treatment. When it is chronic, as it usually is, the man usu- 
ally did it when he was a boy riding horse back or some such way, you will 
have to go .slowly. Suppose the coccyx was tending to be slightly curled up. 
as is frequently the case, you must spring it backward each time. You must 



TREATMENT OF THE SPINE. 55 

go according to the conditions, and must constantly spring the spine toward its 
proper position. I think I explained the troubles which may follow this dis- 
placement, and I do not need to take them up now. 

The sacrum ma}^ be anterior or posterior. I shall consider that more in de- 
tail when we come to the consideration of the pelvis itself. But, supposing it 
were posterior, we would at first, of course, loosen up all the tissues, muscles, 
and ligaments, and then adopt the method I showed the other day — get your 
knee against the bulging portion and spring it inward, a direct application of 
the treatment to the displaced part. It is a good deal like putting a coccyx 
back into place; by training it in the way it should go. Kow you may also get 
the same motion that I showed you and spring the sacro-iliac articulation in 
this way. Then have the patient lie on his back and you can get a very good 
motion for the sacrum in this way; Your hand is placed in this position; the 
knuckles forming one fulcrum and the tips of the fingers the other; there are 
two fixed points, you have the ends of the fingers placed against the sacro-iliac 
articulation, and your knuckles against the table. You thus have two fixed 
points, and you can in this way relax, by an upward, downward and outward 
motion of the limb, all the muscles and ligaments. The weight of the pelvis 
is upon those two fixed points, it gives a considerable spring there, and is a 
very good motion. In case the sacrum is anterior, of course it is very hard to 
apply any direct treatment to it, but use the motion I have just shown you; 
stimulate and relax every part, and depend on the tendency toward the nor- 
mal. You might, by getting pressure upon the side of the pelvis, spring down, 
but I doubt if you could do much in that way. Your tendency, however, 
would be to approximate the innoniinates and to cause it to bulge out. 



LECTURE XL 

At the last lecture I continued the consideration of the theory of Osteo- 
pathic work OD centers, calling to your attention the second view taken by the 
operators as to how we stimulate or inhibit nerve action, the idea being that as 
a rule we remove some lesion, and that that is our strong point in our diagnosis 
— to find some lesion which we may reduce to the normal, and thus, if the ten- 
dency before was toward stimulation, you have removed the lesion and allowed 
nature to tend toward inhibition, and vice versa. Thus you do not have to 
split hairs over the question as to whether you employ a certain motion to 
stimulate and a certain other motion to inhibit. That is, as far as lesion goes; 
you have removed the lesion. I quoted from different ones of the operators to 
show that that was the view generally held. I also called your attention, in 
line with what Dr. Hildreth said, to the fact that sometimes you stimulate 
blood-supply to remove the lesion, which although secondary is still a lesion; 
as for instance we stimulate the blood and nerve force to remove deposits in 
rheumatism, and to cause absorption of abcesses, and things of that kind. 
Thus I had answered two questions propounded and partly the third, as to the 



56 THEORY OF OSTEOPATHIC WORK UPON NKRVKS AND CENTERS, 

effect we have upon nerve centers. Then I went further into the question of 
how we might affect centers, bringing to your attention the fact that the quota- 
tions I made from the operators were given in response to that question, and 
one way was b}^ the removal of lesions; another way was that in any manipula- 
tion of the nerve we must very likely affect centers, as for instance, in getting 
a reflex effect, because from the definition of reflex action we must have affect- 
ed the center, and we often produce reflex action by work upon a nerve, not a 
center. I instanced a case of obstinate vomiting produced by the irritation of 
beans in the ears. The fact that you have removed the bean shows that you 
reached the center; that you worked through a brain center; up one nerve and 
down another nerve to the periphery, to the organ supplied by the nerve. And 
the fact also that we can produce vaso-motor action shows that we have affected 
centers, since vaso-motor actions are essentially reflex. Thus I showed that 
we may affect a nerve by three ways: ist, we may directly affect it and its area 
of distribution by direct work; 2nd we may affect the center by removal of les- 
ion to the nerve; 3rd we may affect a center without removal of lesion; as when 
we produce a reflex action. To-day I continue the same subject. 

I. Theory OF Osteopathic Work Upon Nerve Centers, (Contin- 
ued.) — In the December issue of the Journal of Osteopathy, a theory was given 
in an article by Dr. Lawrence M. Hart, one of our recent graduates, which I 
think was worthy of notice. It was well received at the time, I believe, and I 
have thought that it contained points which would be worthy of our consider- 
ation this afternoon. His idea is that we always remove lesions. His theory, 
in brief, is this: that contractures of muscles occur along the spine, these con- 
tractures along the spine, he says, act in a way to mechanically shut off the 
blood supply in the branches suppl3dng the spinal muscles themselves, collater- 
ally producing a hyperemia in the blood vessels running to the cord, and in 
that way stimulating she nerves, irritating them, and thus leading to inhibi- 
tion, the final result always being an inhibition, and the lesion always being 
contracture. There are certain points with which I do not agree, I will call 
those up later, but I will go over the reasoning that he has followed, bringing 
out his points. In the first place, he says there are two ways in which a nerve 
may be affected through its blood supplj^ and I think that is true. In the 
first place you may have anemia of the nerve, that is, totalpack of blood supply, 
thus robbing it of its nutrition and leading finally to a degenerated nerve, and 
thus paralysis of the part supplied follows. In the second place, you may 
have hyperemia of the nerve, which he claims leads to an irritation, there being 
too much blood thrown to the part, leading to abnormal activity; this leads to 
too much stimulation, resulting in inhibition. Thus, in one case from anemia 
and degeneration you have paralysis; in the other case you have practically the 
same, an inhibition which is liable to be more temporary, because it is produc- 
ed by an over-supply of blood and not by starvation. Thus you see that his 
argument leads always to the one result of inhibition. He calls our atten- 
tion to the distribution of the blood supply to the spinal cord, showing how the 



THKORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 57 

branches from the vertebral, intercostal and lumbar and other arteries in their 
respective regions run to supply both the cord and the spinal muscles, the same 
branch supplying both, that is, dividing to supply both, the posterior division 
running to the spinal muscles, and the other division running to the cord and 
its membranes. Thus he shows the close relation between the blood-supply, 
and states the fact that from the occiput to the coccyx, all of the muscles and 
parts of the cord are thus supplied. Now, his argument here is that in con- 
tracture of muscles, the lumen of the vessels being thus practically closed, the 
over supply of blood is sent through the branch which supplies the mem- 
branes of th3 cord, thus producing a condition of hyperemia about the cord. In 
the first place, this would result in throwing too much blood supply to the 
nerves in question and the nerve centers of the cord, the re- 
sult would be that by over blood supply there would be over stimulation, lead- 
ing finally and naturally to an inhibition of nerve force, and thus you see there 
would always be inhibition. Now, in relieving this condition we of course sim- 
ply take away the lesion, we, by our methods relax these old contractures, and 
allow a return of the flow of blood through them, and thus take away the over- 
plus which is being misdirected to the cord and, through the centers, affecting 
other parts of the body. You see that the point is made that we remove lesions 
and that is one reason why I bring this up, because it illustrates that fact. 
Whatever the result, according to his theory, if I correctly understand it, we 
have always stimulated, but that since we remove lesions and then leave nature 
to work, it is not an essential question to us whether we stimulate or inhibit, 
which I think is another good point, because there has been a good deal of hair- 
splitting as to whether you should give a certain twist of the wrist to stimulate, 
or a certain other twist of the wrist to inhibit. Now, to me, Dr. Hart's theory 
is valuable in bringing prominently to your attention this one kind of lesion, 
contracted muscle, and showing the probable effect produced. That is at least 
one kind of lesion with which we have to deal. He shows the importance 
which we must attach to this condition of contracted muscle, which we fre- 
quently find along the spine. 7 doubt if there will be a day in your practice 
in which you will not find such a condition along the spine. In the criticisms 
I have to make, I do so not to criticise the article, but simply for the purpose 
of bringing out the points which I think will be helpful to you. From his ar- 
cle I do not gather that he allows of other lesions, though perhaps I am mis- 
taken. I do not think he makes it general enough. Now, I think there are a 
great many other lesions along the spine which will affect nerve centers and 
nerve distribution, and saying that contracture is the only cause of lesion is 
far from correct. So that his theory is true only when the lesion is in the na- 
ture of a contracture, and then I do not agree with the explanation, but I shall 
speak of that later. I wish to call your attention further to the fact that we 
sometimes stimulate and sometimes inhibit. After 5^ou have removed the les- 
ion, you sometimes have to do your Osteopathic work upon parts affected, and 
in those cases you must stimulate or inhibit. In the case of head-ache we fre- 



58 THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 

quently have to hold and, as we call it, inhibit the neck, while in the case of 
epistaxis we would stimulate the superior cervical ganglion. Then again, to 
remove the chalky deposits in rheumatism, or in absorbing an abcess, we have 
to stimulate frequently, and in that case, of course, it is not a matter of remov- 
al of lesions. Now, I have said that I think the explanation of the effects fol- 
lowing contracture is only partly true, and for this reason; I believe the theory 
is somewhat too mechanical, making this a mechanical shutting down upon 
blood supply, and thus sending an over-plus to other parts. The theory does 
not, according to my mind, take into consideratien enough the mechanism of 
nerve distribution to the vessels and to the muscles of the back and hence 
I have gone somewhat further, and have endeavored tD explain the condi- 
tions which would follow contractures on the basis of nerve influence. I be- 
lieve that the generally accepted view is that not only the blood vessels of the 
body, but all the functions of life, are directly under the control of the nervous 
system, sympathetic or cerebro-spinal. And hence, I think it would be more 
in line with the accepted theory if we could explain these things according to 
some theory of nervous influence which they have produced. Now, 
it is reasonable to suppose that there is by contracture some vaso- 
motor influence set up. Mechanical contracture would result in stoppage 
of blood to the muscles along the spine, and would, of course, result in an over- 
plus of blood to the cord and its meninges through the collateral branches. 
That would be inevitable, but that condition would hardly be permanent unless 
the vessels were dilated to accommodate it, so that we must look for some sort 
of a nervous action to account for the blood remaining at that place, otherwise 
I believe that the blood would be distributed about the body, and the collateral 
equalization would be set up, and, as you had anemia along the spinal muscles, 
you would have that much more blood in other parts of the body, not neces- 
sarily just along the spine. That is, in case the mechanical theory holds true. 
But I believe you might have in such case not only hypermia of the cord, but 
you might have anemia of the cord and its centers. If the muscles contracted 
and shut off the blood supply mechanically only, you cannot have anything but 
hyperemia; but if you regulate your theory according to nervous mechanism, 
you can have either. There is no question but that contractures are impor- 
tant lesions. For instance we have heart trouble caused by lesions along the 
back. I remember having heard Dr. Hiidreth say that in case of weakness, 
general debilit}^ and irregular heart action he always looks on the left side be- 
tween the shoulders, for some contracture of muscles in that part, and that 
such a condition would usually make the patient despondent. Dr. Hiidreth 
also said that when he found such a lesion on the right side of the spine it usu- 
ally makes the patient "silly;" has the opposite effect. Such is Dr. Hildreth's 
explanation of this kind of lesion along the spine, and there must be some good 
explanation for the results thus produced. Now, as I have said, to me it sterns 
very probable that the contractures act not so much mechanically, as through 
vaso-motor centers and fibers which they involve, and not oniy that, but indir 



THEORY OF OSTEOPATHIC WORK UPON NERVKS AND CENTERS. 59 

rectl}^ through the nervous mechanism of the muscles involved. I quote from 
Gowers on the Nervous System: **The sensory nerves of muscles have been 
shown by Tschirjew to commence not in the muscular fibers but in the inter- 
stitial connective tissue." Then he goes on to explain his theory of why we 
get a "myostatic reflex action, the term he has adopted for "tendon- reflex." He 
says that in such a case the muscle is upon a tension. You remember in show- 
ing you how to produce the knee-reflex I crossed the knees, thus bringing ten- 
sion on the muscles above the knee, then if you shock the muscle, not neces- 
sarily the tendon itself, you get the throwing out of the foot. He bases his 
theory on the sensory nerve-endings between the muscle fibers being impinged 
upon by the fibers themselves. It seems reasonable to suppose that if the mus- 
cle is in a state of tonic contraction there would be a pressure upon the nerves; 
and that is a fair explanation of the sore spots we find along the spine. Those 
sore spots have been started in a contracture; it has become axiomatic that we 
must look for the sore spots along the spine, and you will find that they coin- 
cide with the seat of the lesion, which is the contracture. That theory would 
account for the spot being sore, that is, providing it had not been of too long 
standing, in which case if you find it not sore you might account for it by the 
same theory — that stimulation has gone on until it is equal to inhibition. I 
am a good deal like Dr. Hildreth when he says, "If this theory does not suit 
you figure one out for yourself." And while I am endeavoring to explain these 
things in as scientific a way as possible, if my theories are not correct, it is 
your privilege to do better. 

Now, not onl}^ would we affect the terminal sensory fibers in the muscles, 
but we know that there is a close connection between the spinal nerves and 
the sympathetics and it looks very probable that an effect might be sent from 
a muscle through its sensory terminal right through to affect the sympathetic 
nerves, and thus to affect the general sympathetic life, irrespective of an}^ ef- 
fect you might have through the blood supply upon nerve centers in the spinal 
cord. Thus you get the direct sympathetic effect from the irritation of sen- 
sory nerves. You remember that I quoted from Howell's Text Book a few 
days since to show that nerves were frequently stimulated through their sen- 
sory terminations in the muscles. Now, as I have said, I believe this con- 
tracture, taking the theory that it acts through the blood supply, may thus 
produce either vaso-dilation or vaso-contraction, according to the centers af- 
fected along the spine. I here quote from Kirke: "The vaso-dilator nerves 
in part accompany those first described, but are not limited to the out-flow 
from the 2d thoracic to the 2d lumbar." Further: "The vaso-constrictor 
nerves for the whole body leave the spinal cord by the anterior roots of the 
spinal nerves from the 2d thoracic to the 2d lumbar." Hence, my argument 
is that since you have both vaso dilator and vaso-constrictor centers along the 
spine, according to the quotation from Kirke, that acting on the center af- 
fected you might have either a vaso-dilation or vaso-constriction; you may have 
anaemia or hypermia of the center involved. That looks reasonable to me 



6o THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 

from the theory of nervous mechanism of the blood supply. In case the lesion 
were such that it brought this overflow of blood upon a vaso-constrictor cen- 
ter, that center would be stimulated at first, and the first result would be to 
shut off the blood to the parts affected by the contraction resulting from the 
over stimulation of that vaso constrictor center. Thus you might have anae- 
mia; the constrictor may act in such a way as to entirely shut off the blood 
from a part. Byron Robinson is authority for the statement that the sympa- 
thetics may crowd the blood from a part even unto death. However, suppose 
that the action has gone so far that the stimulation has resulted first in irrita- 
tion, then in inhibition, so that there is a paralysis there, then your constric- 
is lost; your dilators are not opposed and there would be a flooding of the part; 
a hyperemia. In line with this theor}^ I quote what Greene has to say. He 
says that hyperemia of a nerve center leads to, first, an excessive nervous ex- 
citability, together with paraesthesia of sight and hearing, and finally may even 
lead to convulsions. On the other hand, if in the first place the vaso-dilator 
center be affected, you would have the dilators over-stimulated resulting in 
hyperemia, but when it went on, finall}^ resulting in paralysis of those dilators, 
then the unopposed action of the constrictors would set up an anemia, and 
that would be a permanent result. It would lead to death of the part para- 
lyzed from the excessive anemia of the spinal centers and the spinal nerves. 
Thus you get an effect not only upon the spine, but upon the whole distribu- 
tion of that nerve. Thus you can see what would be the probable effect of 
anemia or hyperemia of the cord either from this shutting down of the con 
tractures upon the blood supply, according to one part of the theory, the 
other part of the theory being that this contracture might shut down directly 
upon the nerve and through it send the effect to the part supplied by the 
nerve. Thus you see that contractures along the spine may act as stimulators 
or inhibitors mechanically. So in this case we remove the lesion for its 
own sake, and not simply to stimulate. 

So much for that thought. I wish to take up another question in relation 
to blood-supply, how it affects nerve life, and how, perhaps the Osteopath 
may thus influence nerve-life through blood supply. That is perhaps getting 
the cart before the horse, according to the previous argument, vStill from the 
facts which I wish to bring to your attention it looks as though we might ac- 
complish this. This question is not proven, but I thus throw it out for the 
sake of suggestion. It may lead to a good theory later. The quantity of 
natural, healthy blood in the vessels of a part act reflexly upon the mechanism, 
that is, the vaso-motor nervous mechanism, and thus affect the parts. There 
would thus be a collateral equalization of the blood throughout the body. As 
I stated, the facts that I have to give along this line do not strictly prove the 
point, and I have not tried to make them, but they are valuable as hints. In 
the first place, if Dr. Hart's argument be true that the effect of the blood may 
be stimulation resulting in inhibition, or that it may be inhibition direct, then 
the quantity of the blood in a part, being drawn from the spinal muscles to 



THKORY OF OSTEOPATHIC WORK UPON NE^RVKS AND CENTERS . 6 1 

the centers there, the mere quantity of blood would account for the effect uport 
the nervous mechanism. I use the term, pure, healthy blood, because I do 
not take into consideration the question of the effect of deteriorated blood, 
which you know is a different thing. From Green's quotation we see that he con- 
siders the effect of hyperemia upon nerve centers produces paresthesia, convul- 
sions, etc. Howell's Text-Book states : ''There is in some degree an inverse 
relation between the vessels of the skin and of the deeper structures by the 
reflex mechanism of the vaso-motor centers, " If superficial parts have their 
vessels dilated, deeper parts have them contracted, the flow of blood being reg- 
ulated in different parts of the body according to conditions. The question is, 
what is the stimulation ? There was one of our students who conceived the 
idea that the distribution of the fibres of the solar plexus upon the blood ves- 
sels close to the heart, chiefly the aorta, were stimulated by the flow of blood 
from the heart into the vessels : that they thus acted as vaso-constrictors or di- 
lators, and thus propelled the blood, producing the rhythmic beat of the aorta. 
This student wrote to Byron Robinson, who replied that he considered it a very 
reasonable theory. Hence, you may have the quantity of blood thrown into the 
aorta acting as a stimulant. Green further notes the fact that in hyperemia 
following inflammation, that in other parts of the body there is collateral ane-^ 
mia, because there being too much blood in one place, there is too little in an- 
other place. As I said, I quote these facts as suggestions, and not for the sake 
of proving the theory, but if that theory can be proven, it will be important 
to the Osteopath ; he may mechanically pump blood into a part, as for instance 
by flexion of the thigh, he might repeatedly flex it and pump blood into it and 
thus get a vaso motor effect which is mechanical. Thus, he may get a nerv- 
ous effect through the quantity of blood sent to the part. We sometimes 
make a practical application of such a theory by working upon the splanchnics 
to reduce the amount of blood in the head ; the parts governed by the splanch- 
nics being a sort of a reservoir for an over-plus of blood, and we can work 
it from one part to another. These facts may may be taken for what they are 
worth and may be suggestions for some of you. 

II. How TO Treat a Spine. (Continued.) As to the second part of 
my lecture, I shall try to conclude this subject if possible. There is one point 
I want to give you in relation to the general treatment of the spine. When 
you have acute hyperesthesia, an acute tenderness all along the spine, the- 
Old Doctor treats in the neck, in the cervical enlargement, corresponding in 
general to the spines of the cervical vertebrae, and in the lumbar enlargement 
of the cord, corresponding to the spines of the last three or four dorsal and the 
space between the 12th dorsal and ist lumbar. 

There is one treatment that I have not shown you. It is a treatment I 
have not seen any of the ladies use. It is a treatment in which the operator 
simply brings his weight to bear in this way. That is what I have denomina- 
ted as the "straddling treatment." 

I mentioned to you that we frequently get noises along the spine which are 



62 THEORY OF OSTEOPATHIC WORK Ut»ON NERVES AND CENTERS. 

due to motion between parts, and in some cases that that was due to a slipping of 
parts of the ribs to their place, and when I have worked along the spine by get- 
ting direct pressure over one side only and I have not been able to produce these 
noises with their accompanying result, it was probably because I did not get 
equal pressure upon both sides, but when I adopted this "straddling movement" 
it brought equal pressure on both sides, then I could get that sound and the 
good effect following the replacement of the parts in that way. 

I might call your attention to the technique of stretching some of these 
scapular muscles. You will, in your treatment of the upper part of the spine, 
either to reduce contractures, or to loosen the muscles along the spine, 
£nd that you must stretch these scapular muscles. It is a good plan to push 
the patient's arm w^ell down to the side on a level with the table, then, putting 
the hand beneath the scapula until the fingers are overlapping the spinal edge 
of the scapula, the shoulder blade has been approximated to the spine, there is 
not much space between the spine and the edge of the scapula. By holding 
the muscles firmly against the edge of the scapula you can stretch so that by 
bringing the arm across the chest you bring a tension upon the scapular mus- 
cles. By use of the thumb on the scaleni muscles at the side of the neck, 
bringing the arm up over the head, with your thumb over those muscles you 
can loosen them, this being a preparatory step to the setting of the first and 
second ribs. You must have those muscles relaxed, and you get the effect in 
this way as well. Just hold them with one hand while you push the elbow up 
toward the head and around toward the body. Those are motions frequently 
employed in practice. 

There is a question now as to how to reach the psoas muscle. It is one of 
the flexor muscles of the thigh. It is a good plan to simply straighten the 
legs out and then bow the back inward at the lumbar region ; that gives it 
some little stretch and gets an effect upon the psoas muscle. The lumbar 
plexus is formed in the substance of the psoas muscle, and if it is contracted 
you may have trouble wdth that plexus. I want to show you one other motion 
-which it is sometimes necessary to use, though with great moderation. I show 
it to you principally to warn you against its use. The patient lies on his face 
and you lift the legs from the table and then work from side to side ; 3^ou can 
thus stretch the psoas muscle often more than you did before, and by working 
upward along the spine, one operator placing his hand on one side of the verte- 
bra, the other on the other, you can thus bring pressure against either side of 
the vertebrae. This is the treatment called "breaking up the spine." It is fre- 
frequently used with very good effect in cases of diarrhoea, flux and other 
troubles. The warning is that 3^ou should not raise the knees high above the 
table ; if you do that and bow the back too much you may have serious results, 
and the Old Doctor has cautioned us against any such performance, so you must 
be extremely careful, though the motion is useful in reaching certain troubles. 
You might not only strain the spine and the anterior ligaments, but you 
atright tip the parts of the pelvis. Dr. MtConnetl spoke of a case which had 



THEORY OF OSTEOPATAIC WORK UPON UPON NERVES AND CENTERS. 65 

been injured in that way, and which has been serious ever since ; he said he had 
found that the innominate bones had been slipped, and that there was an ine- 
quality at the symphasis of the pubes. 



LECTURE XII. 

I wish to recapulate a little in regard to the nth lecture. At that time I 
brought up the theory of work upon a spine through the effect we could get 
by removing lesions in the shape of contracture of muscles. I referred to Dr. 
Hart's theory, which was a good one; his idea being that the contracture of 
muscles shut off the blood supply in the muscular branches of the arteries, and 
the overplus is thus thrown to the cord and affects oenters and nerves, stimu- 
lating at first, but afterwards leading to inhibition. I explained how his view 
led up to that result. I then went further and endeavored to show that such a 
process must necessarily be by affecting vaso-motor nerves, otherwise the blood 
would not be retained about the centers of the cord to influence them. And 
further, that we might have an effect not merely upon the vasomotor nerves 
and their centers, but we might have an effect directly through the terminal 
sensory branches, running from the muscles, upon sympathetic and internal 
life. I then brought merely to [your notice, without attempting |to prove it, 
the point that possibly the amount of blood in a part would account for certain 
nervous effects. Then again the theory of Byron Robinson, that the pumping 
of the blood from the heartjinto the aorta may set up a reflex action. And finally 
the quotation from Green's Pathology that there was always a reflex arrange- 
ment of the circulation, that if the superficial vessels were dilated, the deep ves- 
vSels were contracted, and vice versa; and from these and other facts it seemed 
probable that we, by working mechaniralh^ as for instance pumping blood into 
the limb, bring a certain quantity of blood to act upon nerves, we could in- 
fluence nerves and centers. However, as I said, the theory is a little hard to 
prove. 

I. Theory of Osteopathic Work upon Nerve Centers. (Con- 
tinued.) — I wish to continue the same general subject to-day, going a little 
further into the question of contractures; their occurence, nature and cause. 
Now, as to the occurrence of contractures along the spine and in other parts of 
the body, their importance I think was fully brought out in the last lecture, in 
showing you how important they become when considered as lesions along the 
spine, especially from an Osteopathic standpoint. We, as Osteopaths, find a 
great deal to say about contracted muscles, and I think we are backed by the 
authorities when we are talking about them. When we get out in practice and 
tell a patient that there is a muscle in his back or neck which has become con- 
tracted and failed to let go, he is sometimes inclined not to believe it, because 
the popular idea is that a muscle contracts and lets go when you wish it to, 
and that it simply cannot contract and hold on. You will also find that when 
you get out among the medical fraternity they will try to pick flaws in your 



'64 THEORY OF OSTEOPATHIC WORK UPON NERVE CENTERS. 

argument, and unless you are backed up by authority, you hardly feel so strong 
in argument as you otherwise would. Hence, I have taken up this question a 
little further to show that what are termed "contractures" are recognized by 
the different authorities. Howell's Text Book says: "A contracture is a state 
of continued contraction of a muscle." Gower on the Nervous system says: 
"Tonic spasm, persistent and involving only a certain group of muscles, causes 
distortion of the parts to which they are attached, and is termed a contracture." 
In the Journal article which I quoted at the last lecture a quotation is made 
from Dr. Allen's work on human anatomy, which is as follows: "An abnor- 
mal phase of tonicity is met with when a muscle sustains unduly prolonged 
action of its fibers; under these circumstances a shortening of its belly takes 
place, which persists as long as the cause of the contraction is maintained. 
Such abnormal modification of contraction is termed contracture. Stretching 
of a contractured muscle is readily accomplished and maintained, provided the 
cause for the contracture is removed. Contracture, clinically considered, is a 
subject of great importance. In lateral curvature of the spine contracture of 
muscles will take place on the side of' least curvature." Hence, you see that 
the authorities agree, they say that contractures are of considerable clinical im- 
portance; they say that they cause distortion of parts to which they are attached. 
Hence, you see that others besides Osteopaths attach significance to this con- 
gested condition of the muscle which we call contracture. But it is important 
perhaps, in taking up this subject, to show that the Osteopath, in work upon 
contractures, in treating them as lesions and in removing them, is thoroughly 
.scientific and has the weight of authority and science behind him. There is a 
question as to what the nature of a contracture is. We saw from the quotation 
above that Gower understood it to be tonic spasms; then Howell's Text Book 
says that continuous contractions may be caused b3^ continuous excitation, and 
it regards it as a tetamis. Such a condition of a muscle may be found also in 
involuntary muscles. When you are in practice you will find that frequently 
in your work upon the intestines that thej^ are drawn and hardened; you will 
find the stomach hardened to the touch, and this is an abnormal tonicity which 
is regarded in the same light as contractures, although that term is not applied 
to it. You will get so that you will recognize by touch the normal feeling of 
the abdomen, and hence will be able to recognize any departure from the nor- 
mal. Kirk is authority for the following statement: "Though involuntary 
muscle cannot be thrown into tetanus, ii has the property of entering into a 
condition of sustained contraction, called tonus," which is, as far as our pur- 
pose goes, practically the same thing. You will find in your work that there 
is quite a difference between the feeling that you get from contracted muscles 
in the back and the feeling that j^ou get when working upon the abdomen. 
Now, the external muscles of the abdominal wall may be contracted as well as 
those internal muscles, and you will find often the outer covering of the abdo- 
men much contracted and hardened. x\s I said, you will have to learn by ex- 
perience what is the natural feeling of the muscles in the back and muscles in 



THEORY OF OSTEOPA.THIC WORK UPON NERVE CENTERS. 65 

the abdomen, and how they have departed from that by becoming contracted. 
Then, again, the question comes, "Is it not exercise that makes these mus- 
cles hard, particularly in the back? Therefore, how can the Osteopath recog- 
nize the difference between the normal hardening of a muscle due to exercise, 
and a contraction of the muscle which is called a contracture? There are var- 
ious ways, some of which I shall give you later in the lecture, but one way is 
that when a muscle is hardened by proper exercise it is homogeniously harden- 
ed, the same degree of hardness all over it; while when you come to feel of a 
muscle which is contracted, you are apt to find it raised in welts. We shall 
find the reason for that presently. Of course there is contracture which, ac- 
cording to the definition, would be called contracture, but different from what I 
have been describing. That is in set limbs in rheumatism, and things of that 
kind, but you will recognize those readily by the the case itself. 

Now, we usually find these contracted muscles not only in the back and 
abdomen, but we find them frequently in the neck, and that is one important 
place that you will have to watch for hardening of muscles. The explanation 
of the contracted muscle rising in welts on the back: When you work upon 
the back you will find that parts of muscle slip under your fingers, as if you 
were working over a whip cord or something hard; that is what is called a welt. 
You will, of course find muscles normally contracted to produce motion, I 
take the following quotation from Gower, which will explain itself. "Every 
movement is due to a contraction of a series of fibres, which seldom corresponds 
to the series massed together in a muscle." That is, you frequently 
have a contraction of different fibres, you might say a sort of a wave 
of contraction running through different fibres of different muscles to 
produce complex movement, and he says that it is seldom that these 
movements are massed together in a muscle. Ofcourse there are 
prominent exceptions to the rule, one being that of the biceps. 
He goes on to say: "Fibres, not muscles, are represented in the structure of 
the brain, and those that cause a simple movement may be in several muscles." 
HeDce, you see that a derangement of a certain part of the motor area in the 
cerebrum may cause a lesion of parts of several muscles, or a lesion of different 
nerve fibres of the muscles may cause a contraction of parts of dift'erent muscles. 
Howell's Text Book states: "If the muscle be in an abnormal state the con- 
traction may remain localized as a swelling or welt." That is the term by 
which we usually describe those contractions. 

The Osteopath is sure of his grounds scientifically when he says to a pa- 
tient that the muscle has contracted and has failed to relax When he finds 
that such a condition is present it is a basis of work on his part, to be treated 
as a lesion, and when he describes ii as a welt, he is in accord with the au- 
thorities. 

The question naturally conies, "What is the cause of these contractures?" 
The Osteopath regards them as peculiarly significant from his standpoint. We 
noted, ;,in quoting from Howell's Text Book that he said constant irritation pro- 



66 THEORY OF CENTERS: CONTKACTURES.- 

duced constant contraction, so it must be some irritation which: is continually 
acting upon the muscle itself or upon its nerve connection, causing it to act in 
this way. That of course would lead you to inquire if the irritation came 
through the sympathetics. You will find some of the visceral diseases sending 
a continous impulse over the sympathetics through the spinal nerves to the 
muscles of the back. Dr. Billroth, in the article quoted from the Journal, 
states: "Contracture of muscle, is due to disease of the muscles, to primary 
disease of the nervous system, to loss of antagonism, as well as to excessive use 
of one set of muscles over another." Gowers, in speaking of nerves and mus- 
cles says: * The excitability is changed by disease, of which the change is of- 
ten an important symptom." (That is, the change in a muscle or nerve is fre- 
quently an important S5^mptom of disease.) "It indicates the state of nutrition 
of the nerve fibres and muscles, and from this we can draw important inferences 
regarding the condition of the centers. " Gowers states that paralysis or ab- 
normal excitabilit}^ of a nerve refers back to the nerve center controlling it. If 
the abnorfnal excitability has been such as to result in contraction, it will refer 
us back to the point from which the irritation came, it may be the distant cen- 
ter or distant periphery of some othar set of nerves reflected back sympatheti- 
cally. 

In discussing before you previously to this the Osteopathic view of con- 
tracted muscles, I said that the Osteopath regarded them in one case as primary 
and in another case secondary. Primarily, you might say, is where a muscle 
is directly acted upon by some external force, some blow, strain or draught of 
cold air, causing it to contract. Your contraction then is your primary lesion. 
It will impinge upon the nerve fibres, as we saw a few days ago in quotations 
from one of the authorities, that the terminal sensory fibres of the muscles 
are irritated by contractures, and that constant irritation may be set up and 
carried into the system anywhere, according to the centers affected. This then, 
would be a primary lesion. A secondary lesion would be one of the kind des- 
cribed a few minutes since, when I noted the fact that we might have stomach 
trouble producing secondarily a lesion of the muscle of the back producing 
welts; so-called contractures. When the lesion is primary, of course that indi- 
cates at once to us where the trouble is, and you, as Osteopaths, have learned 
by this time that you must go to the seat of the trouble; even though you 
have to trace it a long way back, you will finally come to it. So that when 
you have the contracture acting as a primary cause of disease from its nervous 
connections, then of course by removing the contracture, you have removed 
that which is irritating or inhibiting. You have restored the normal, and al- 
lowed nature to take care of the balance. When it is secondary, it is a symp- 
tom, as Gower says, of a diseased condition of a center; it may be, and so the 
Osteopath treats it. In case the diseased stomach has caused a contracture in 
the back, we could not say that by removing that lesion that we have removed 
the primary cause itself. But the value of that to the Osteopath is, that he 
thereby sees where the trouble is; it is to him a symptom, and he can trace it 



THKORY OF CKNTEJRS. CONTRACTURES. 67 

back, and aided by other symptoms, find the original cause. Not only that 
but, according to what we have learned previously, the effect that the Osteo- 
path can have by working through nerve terminals may be gotten. He can 
work upon these lesions, which are secondary, and remove them, and he can 
thus affect the peripheral terminations. Now, if the cause works backward 
over these nerves, then his work can reach forward along the same track, and 
he can get an effect upon the original seat of the disease. He can stimulate 
the stomach, in other words, by working along the back in the region of the 
splanchuics. Of course he would combine work upon the secondary lesion with 
woik upon the original cause of the disease, whatever it was, and his good 
judgment and ability to diagnose would have to tell him when the lesion was 
primary or secondary. I recollect a case of chorea which we treated at one 
time in Evanston, which had been of seven years' standing. It was the case 
of a young lady who was some twenty years of' age, and it was very bad when 
brought to us. She tossed about and nearly threw herself from the table, and 
it required one to hold while another treated. The lesion in that case we found 
mostly along the back on the left side of the spine; the muscles were in a con- 
tracted condition all along that side of the spine. We also found that the 
muscles in the neck were quite stiff; we were particular to remove that con- 
gested condition of the muscles, and the cure was complete although the case 
had been of seven years' standing. It was quite a satisfactory case. Now, 
the question is, whether that was a primary lesion or a secondary, and it is 
very hard to say. The causes of chorea are external sometimes — rheumatism 
or exposure — and in such a case the lesion may have been primary, the effect 
of exposure or rheumatism may have hardened the muscles in the back. In 
other cases it is due to over-work, worry and a whole list of different causes. 
So it may have acted indirectly, and thus have produced these contractures. 
By working there we remove that lesion, whether it was primary or secondary, 
and we get our results. Of course we used general treatment with the special 
treatment which we gave to the lesions. My chief purpose in following this 
line of thought was to show that the Osteopath in talking about contractures, 
in treating them as lesions, and in working directly upon them as such, is 
thoroughly scientific. As I showed you in previous lectures, he can work upon 
nerve terminals in these muscles and thus gain important results. And I think 
that an Osteopath in an argument with a ph3^sician ought not to come out sec- 
ond best. 

There is one further point which I want to bring out; and that is the fact 
that you will find flabby muscles, and when a muscle has become flabby it is 
usually an indication that the disease has progressed to a considerable degiee. 
Very frequently these muscles have lost their tone, and our mode of reasoning 
is that we must restore life to them. I wish to state what Cowers has said in 
this regard. He says: That when a muscle is thus flabby, it shows some 
lesion of the nerve fibers controlling the muscle. And pathology has shown 
that section of a motor nerve of a nuiscle will lead to deterioration in the con- 



68 EXAMINATION OF THE NBCK. 

dition of tli€ muscle. Hence, there is close trophic coniiectioii between tihe 
nerves and the muscle fibers, so that, reasoning from that, when you find a 
flabb}^ condition of a muscle, you must have a diseased condition which has 
advanced considerabl3^ 

In previous lectures I have considered full}^ the spine. First, how to exam- 
ine it; second, how to consider the lesions found, that is, their significance; 
and third, how to treat your lesions when found. I know of no other points 
which I should bring up in that connection. I shall, therefore, go to the neck, 
and tell 3'ou of its indications. 

II. Landmarks CoNCERXixG THE Neck: — First, as Holden says, we 
note a great difierence between the skin on the back of the neck, where it is 
very thick, and that on the front of the neck, which is extremely thin; this is 
the best place in the body to note that difference. The external jugular vein 
corresponds with a line drawn from the angle of the inferior maxillary bone to 
a point at the middle of the clavical. We find in certain heart troubles a 
venous pulse can be detected in that vein, we can see it from a distance. There 
is a case in town in which the venous pulse can be seeo in the jugular vein. 
There is also a venous hum in that vein in anemia. 

The hyoid bone is on a level with the lower jaw; the gap just below it 
corresponds to the apex of the epiglottis; therefore an)- deep cut at that point 
leaves almost the whole of the glottis above the cut. The thyroid cartilege is 
familiar to 3'ou all, and you can by feeling carefuU}" trace out both the upper 
and lower cornua. The lateral lobes of the thyroid gland lie on each side of 
the thyroid cartilage; the bridge lies across the middle, and in that region j^ou 
can feel the pulsation of the superior thyroid artery. The crico-thyroid mem- 
brane, as you know, joins the th3Toid and cricoid cartilages, and that is the 
point at which laryngotomy is performed. The level of the cricoid cartilage 
corresponds to the interval between the fifth and sixth cervical vertebrae; it is 
also the level of the oesophagus. Hence, if a child has attempted to swallow 
something too large for it, it will probabh^ be lodged in that place. The su- 
perior opening of the oesophagus is usually an inch and a half above the ster- 
num, but it may get as far as two and a fourth inches above the sternum. Nor- 
mally about seven or eight rings of the trachea protrude above the sternum, 
but the3^ are not felt from the outside, being covered b}" other structures. Sur- 
gical operations are conducted in the middle line of the neck, which is called 
the "line of safety." 

in. How TO Examine the Neck: — Of course you all know that there 
is nothing of greater importance to the Osteopath in the body than the neck 
Dr. Harry Still is authority for the statement that almost all diseases of the' 
body can be treated through the neck. Of course that is putting it very broad- 
ly, but it is very expressive. You can treat in the neck alone and affect the 
stomach, heart, liver or intestines and you can treat, of course, in the neck and 
affect the brain, or affect the vaso-motor life for the whole body. 

In the examination of the neck I have divided the subject into first, the 



EXAMINATION OF THE) NECK. 69 

throat. You all know where to find the tonsil, just beneath the angle of the in- 
ferior maxillary bone; it is very readily felt when you want to find it, in case 
of tonsilltis it is easily found. If you cannot find it on the outside, you can 
examine inside the throat. So in examination of the throat you must always 
look for the tonsils if you suspicion tonsilitis. You must look for tender 
points about the throat, and where we frequently find them is, in case of catarrh, 
just below the angle of the jaw. I will not vouch for the statement, but it is 
made on good autharity. Further, in examination of the throat, alwaj^s look 
to see what is the condition of the hyoid muscles. They are of great import- 
ance to the Osteopath — those above the hyoid bone and those below it; either 
or both may be contracted, congested, or drawn, shutting off the blood supply 
to the other parts of the head or the throat, causing very numerous troubles. 
Of course you must always examine your patient to see that all parts are 
normal. You should direct your attention first to the hyoid bone, then to the 
thyroid and cricoid cartilages, not because we find them of great Osteopathic 
significance, but to see that everything is normal. Of course, in order to rec- 
ognize the abnormal you must acquaint yourselves with the normal. The thy- 
roid gland itself has^been described. You should bear in mind that it may be 
enlarged in disease, as in goitre, or it may be atrophied, as in myxedema. You 
will be able to find it very readily, and you must decide whether it is enlarged 
or wasted, and therefore, you must know what is its normal size. 

You will frequently find that the lymphatics are enlarged in the neck; the 
kernels are found along the course of the veins in the neck. The lymphatic 
glands sometimes become enlarged, and remain so for years, showing that there 
is some irritation or some septic process still going on. In people with chronic 
sore throats we will frequently find that the lymphatic glands are enlarged, 
sometimes they are left so by diphtheria, or any disease which leaves in the 
system a septic product, which of course is taken up by the lymphatics. So 
you must look to see whether or not the lymphatics are enlarged. If they are, 
of course the treatment is not to them, but is to remove the cause of the dis- 
ease. 

A further point as to the anatomy of the neck in connection with Osteop- 
athy: you will find that the glossopharyngeal, pneumogastric and spinal ac- 
cessory nerves leave the skull through the jugular foramen. The pneumo- 
gastric runs on down just behind the anterior border of the sterno-mastoid 
muscle, and we work upon it as we work along the muscles, Frequenth' we 
work upon it high up at its exit from the skull, that is, as near as we can get 
to it. We can usually bring pressure upon the nerves at that point. Fre- 
quently, also, we work upon these nerves through their sympathetic connec- 
tion with the superior cervical ganglion. 

The phrenic nerve, as you know, springs from the 3d, 4tli and 5tli cer- 
vical nerves, and you reach it at the anterior border of the scaleui muscles, 
right along the edge of the transverse processes of the vertebr.x. You can 
.impinge upon tlie nerve by pressure between the sternal a,ud clavicular origins 



yo THEORY OF CKNTKRS. CERTAIN LESIONS. 

of the sterno- mastoid muscle. That is where the treatment is usually given in 
case of hiccoughs. 



I.ECTURK XIII. 

At the last lecture under the general head of theory of work upon centers, 
I considered contractures, their occurence, nature and cause. I explained, 
according to the authorities, how these contractures happened, and that this 
was the scientific definition, the term meanining continued contraction. I quot- 
ed from Gower's, Howell's Text Book and others, to substantiate the pomt. I 
called to your mind the clinical importance that is attached to these conditions, 
especially by the Osteopath. I called to your mind their nature, that is, that 
they are called a tonic spasm, being considered in the nature of a tetanus; also 
the fact that the continued tonicity of the involuntary muscles might exist, 
which for our purpose is practically a contracture, although not called so. I 
called 3^our attention to how you might recognize the difference between these 
conditions by the touch. The chief points where these occur are in the neck, 
back and abdomen, as well as the limbs in some cases. I called to your atten- 
tion the fact that muscles normally contract not as a whole usually, but as sep- 
arate fibres of several muscles, according to Gowers' authority, and that ac- 
counts for the appearance of welts; the feeling of welts under the fingers. That 
the cause was some constant irritation, some direct injury to the muscle, or 
some exposure or something of that kind. That is, that the contracture might 
be primary, as in the case of a blow or injury; and secondary when a muscle 
contracts due to a trouble which is far removed, as for instance muscles over 
the splanchics contracted secondarily to the affection in the stomach. I noted 
that muscles which felt flabby were a sign that the disease had probably pro- 
gressed for some time? and that the centers and nerves were affected. I also 
called your attention to certain landmarks in the neck. Todav I wish to con- 
sider the same general subject further. 

I. Theory of Osteopathic Work Upon the Nerve Centers, (Under 
the Special Head of Further Possible Lesions.) — I have explained to you the 
nature of some lesions, at the the last meeting the nature of a lesion when it is 
a contracture. I have also called to your mind other lesions, such as a slip of 
the vertebrae, a displacemeat of a part, bringing pressure upon a blood vessel or 
upon a nerve. I believe I mentioned tumors at one lecture, but I shall carry 
that idea further at some time. Also I mentioned the lack of normal blood 
supply being anemia, or perhaps too much blood, being hyperemia. So that 
we have already considered certain lesions which may affect the body, may act 
through the nerve and cause disease, 

A further very important lesion which we frequently find in our 
work is a thickening of ligaments following a strain or some injury. 
Pathology teaches us that after having irritation we frequent- 
ly have an infiacnmation. That means that too much blood is circulated about 



THEORY OF CENTERS. CERTAIN LESIONS. 7 1 

the part, and in the natural process of inflammation an exudation follows, 
first fluid, latter cellular, of both kinds of corpuscles. When this state of inflam- 
mation has gone far enough you have resulting a new growth. We know that 
this new growth is connective tissues or scar tissues. It will be seen in a di- 
sease called cirrhosis of the liver, usually induced, or sometimes at least, by 
the drinking of alcohol. The alcoholic poisoning sets up an inflammation. Fol- 
lowing this inflammation there results a growth of new connective tissues, the 
connective tissues normally occuring throughout the liver are thickened. Now, 
this new growth of connective tissues is all right as it is new and* fresh and 
filled with blood vessels. But sooner or later the blood vessels begin to be 
contracted and absorbed and the tissue loses its blood supply and then it be- 
gins to contract and become pale. When that process has gone far enough, 
the contraction has acted mechanically and shut down upon the blood supply 
passing through the liver, thus the portal circulation is obstruced, and the blood 
sets back and produces what is known as ascites, or dropsy of the abdomen. 
There you have a thickening of the connective tissues, you have resulting from 
that a condition of pressure, a shutting down of the thickened tissues upon the 
part concerned. In sclerosis of the spinal cord you have a thickening of the 
connective tissue either at die expense of, or following, degeneration of the 
nervous elements of the cord. When you have had a wound, say a cut with a 
knife, you have, in the process of healing, the formation of what is known as 
granulation tissues, this is followed later by the appearance of blood vessels in 
new connective tissue, and you have your scar. So-called scar tissues occur 
not only'after cuts and woundh, but after abcesses and various pathological pro- 
cesses in the body. I wish to bring these things to your attention for the pur- 
pose of showing you that it is a constant and very general pathological tendency 
in the body to produce new connective tissue, and it is the tendency of that 
connective tissue when produced to contract. There you have something that 
is a very frequent source of disease, and it is of especial interest to the Osteo- 
path, from his point of view, since it means that there may thereby be a me- 
chanical lesion, a direct shutting down upon the parts. You have all known 
of cases where a scab has formed upon some externel sores, catching some sen- 
sory nerve terminals in its connective tissue, as it becomes old and commences 
to contract, it irritates those termination of nerves, producing constant pain in 
the part. 

I wish to quote from Green's Patholog}^ where he saj^s: "The new con- 
nective tissue is called inflammatory or scar tissue. The tendency to contract 
is characteristic of this new fibrous tissues. This contraction of scar tissue 
may produce serious results." You will readily recognize the Osteopathic sig- 
nificance of anything that will contract or obstruct the channels of blood or 
nerve force. These causes are especially significant, it seems to me, in relation 
to the spine, so I have considered that first. Now, what may the nature of 
your lesion be? As I have said before, it might be a vertebra displaced: it may 
be twisted or slipped, or in any way so placed as to bring irritation upon the 



72 THEORY OF C^NTF^RS. CERTAIN I.KSIONS. 

parts surrounding it. It makes no practical difference for our purpose whether 
first, that irritation acts upon nerves or upon blood vessels, just so it be suffic- 
ient to act upon the ligamentous parts about the vetebrae to irritate them. You 
will then have an inflammation. Secondary to this irritation you may not have 
inflammation, but hyperemia. Following this inflammation you would naturally, 
according to the laws of disease, have a thickening of the connective tissue. I 
wish again to quote from Green, speaking about inflammations, and under the 
head of injuries, slight but long continued," he says: "In many cases the in- 
flammatory^ process ends in the formation of new tissue — inflammatory fibrous 
tissue." You will notice there that the injury may only be slight, but long 
continued. Such is the nature of a great many lesions that we find in the spine. 
A man comes to the Osteopath's office for examination. He says: ''You have 
had a strain or twist here in the spine in some way." The patient says he 
never had any strain there. The Osteopath still thinks that he must have had 
a strain there. The reason why he did not know it was simply because it was 
so slight as to escape observation, and has not been attended to because slight, 
and therefore has been long continued, and finally results in some process of 
pathological growth. Further, Green says: "If the hyperemia be of long du- 
ration or frequently repeated, the epithelium and connective tissue of the part 
increase." So an inflammation is not always necessary to produce thickening 
of the connective tissue but it may occur from hyperemia. Too much blood 
about a part may, according to Green, either cause a thickening of the pitheliume 
or of the connective tissue. So your lesion which has produced nerve irrita 
tion and caused inflammation, may be slight, or on the other hand, may cause 
hyperemia, which may not necessarily be known to the patient. So much, 
then, for the tendency of these newly formed tissues to contract and to obstruct. 
From what I have already said you will see the significance of these things 
from our standpoint, as I have already explained to you the effect of thicken- 
ing of tendons or hardening of muscles or ligaments. 

Your lesion may be not only in the nature of some si ip or twist of the ver- 
tebrae, but, secondly, it may be a strain, a pull, a cold draft, or something of 
that nature — external violence. You are all familiar with the phenomena 
which follow a sprained ankle, as we call it, and you have probably often heard 
the physician say that such an injury was in some cases worse than a broken 
bone. You have, following a strain, an inflammatory process, and 
you have following that inflammatory process, of course, this 
thickening of the connective tissue. Then, again, you may 
have a lesion in the nature of bad blood. If the blood is not pure, and if 
all of the excretory organs of the body are not doing their duty, the bad blood 
then acts as an irritant and may inflame parts. Your lesion may, fourthly, 
be in the nature of some exposure, or cold, or rheumatism. Quain, in his dic- 
tionary, speaking of disease of the spine, says: "The ligaments here, as in 
other parts of the body, are especially liable to a rheumatic form of inflamma- 
tion." Inflammation means to us the formation of a new growth; a new growth 



very probably raeans the formation of an obstrttctiofi, which 
of course acts as a continual irritation upon the part affected, with all, the con- 
comitant results. In view of the above facts, may not any Osteopath see the 
tremendous [significance from his standpoint of slight, or it may be severe, 
sprains, slips, twists, subluxations, injuries, exposures, and the like? Can he 
fail to recognize the importance of such factors in the causation of disease, or 
can he disregard the therapeutic value of their removal? It seems that when 
we look at these things from an Osteopathic standpoint, they become fraught 
with great significance, and to my mind, nothing is more encouraging to an 
Osteopath than the thought that he can go about to remedy these pathological 
results. I have brought this up because it seemed to me that these were Osteo- 
pathic points. Hence, you will note the importance of what we have already 
said in previous lectures, that you should always and under all circumstances 
look for lesions. You should always, also, inquire into the history of the 
case. 

The method of questioning is one of the valuable means by which we diag- 
agnose the case, it is the only thing that leads us into the history of the case. 

These lesions, such as described, are of particular importance to the Osteo- 
path because you know that a contraction may cause, for instance, distortion of 
a part, as we frequently find in our practice. When a part has left its normal 
position it may very likely be obstructing some of the fluids of life, or pressing 
upon important parts, thus producing disease. So that the result of the lesions 
may not only be distortions but may be obstruction of parts; further, they may 
lead to ankylosis or ossification of the parts. Quain's Dictionary in speaking of 
Pott's disease, says: **In the majority of cases ulceration of one or more inter- 
vertebral cartilages occurs as; a result of sub-acute inflammation; if the case 
proceed favorably toward a curative termination, the destructive process becomes 
arrested and a healthy process is re-established, terminating in bony ankylosis 
between the bodies of the vertebrae; ossification also spreads along some of the 
ligamentous structures passing between the laminae, as well as between the spin- 
ous processes." "Thus," he goes on to say, "the resulting posterior protusion 
becomes a persistent deformity, a deformity essential to the cure of the disease. ' ' 
Pott's disease, I might say, is the extreme posterior curvature of the spine, also 
commonly called hunch-back. Now, as to this explanation, there are several 
points to which I wish to invite your attention. In the first place, it empha- 
sizes the importance of inflammation, as he says the condition may result from 
inflammation between the bodies of the vertebrae. Further, that that inflam- 
mation may be the result of some rheumatic process startee in the ligaments 
about the spine. Second, that the result may be ankylosis or ossification, if 
the case has gone far enough. Third, to the Osteopath it is difficult to call a 
deformity a cure; that is what we call disease; patients come to us with deform- 
ities to be cured. It has been a matter of some surprise that I noticed that not 
only Quain, but others, for instjance, Hilton, speak of cure by fixation or ossi- 
ficatiGn of parts. Now, I do not call, this to your attention to tell you that 



74 THEORY OF CENTKRS- CERTAIN I^ESIONS. 

you can cure every one having ossification or ank3dosis of the vertebrae. How- 
ever, there is a kind of ankj^losis that may be cured bj^ the Osteopath and that 
is the ligamentous form. When it has reached ossification it is beyond our 
power. What the Osteopath is called upon to do in such a case, where there is 
fixation of parts of bony growth, is to give relief or perhaps strengthen the 
general condition of the body, which he can very frequently do. The peculiar 
work of the Osteopath, in cases which are proceeding to such a termination, is 
not that he may remove the ankylosis or the ossification, but that he may pre- 
vent its forming. I think our practice justifies the statement that he can pre- 
vent such things. A great many cases of spinal curvature have been cured 
outright, and there is no telling what the termination of such a case of spinal 
curvature may be. However, they might have gone on to ossification or anky- 
losis of the joints. The simple facts are that cases of deformity have been sav- 
ed from being permanent, and that people have been saved from the lives of 
cripples time and again by Osteopathic therapeutics. And so these things are 
significant to us more in a prophylactic light, that is, that we may prevent 
their growth. 

For examples of the general cause of disease following a slip or strain 
which has resulted in a thickening of ligaments, I wish to note several cases: 
I have had cases in which, along the region of the splanchnic nerves, there was 
a tightening of all the ligaments, the parts of the spine being approximated. The 
result of that lesion was some form of stomach trouble. I have seen a case of 
neurasthenia, which I would attribute to such a cause. W^hen practicing in 
Chicago we had a gentleman who was in rather a remarkable condition. 
His general trouble might be described as neurasthenia. His trouble was 
largely circulatory and nervous. He had a skin as soft as a baby's almost; 
a ruddy complexion; looked strong and healthy, and one would hardly think 
there was anything wrong with him. But he said he would at almost any 
time break out into a perspiration, when there was not any heat at all or exer- 
tion to account for it, or perhaps he w^ould be chilly. Then, again, he would 
flush up following any exertion. He would have trouble with his head, and 
could not work at times. At times he would be bothered with sleeplessness. 
Now, those w^ere general nervous troubles and troubles of the circulation. He 
was a man, who on account of his disease, led practically an outdoor life. The 
lesion in his case, according to our examination was along the spine. We 
found that the ligaments along the spine seemed to be tightened, and that the 
muscles were contracted. Now, whether or not the theory fits the facts, and 
whether or not all these these things are brought out properly, it seems to 
me they explain, at least theoretically, what we do w^hen we meet similar cases 
and go to work to remove such lesions. Such lesions then, may come, first, by 
direct impingement and irritation of the nerves. As, for instance, where they 
emerge from the spine at the intervertebral foramina. Second, they may act 
through the blood supply, as was shown in a lecture or two since, by causing 
anemia or hyperemia of the centers or the nerves. This hyperemia or anemia 



LANDMARKS OF THK NECK. 75 

may be collateral on account of the condition of the circulation to the spinal 
muscles, or the anemia may exist directly by pressure at the intervertebral for- 
amina on the anterior and posterior spinal nerve branches, or perhaps pressure 
in the same way on the vertebral branches of the arteries, and thus shutting 
off of the blood supply to the cord. 

II. lyANDMARKS CONCERNING THE Neck : — Holdcu uotcs the stcmomas- 
toid muscles, which he calls the surgical land-mark of the neck, and calls to 
our attention the fact that it stands out in relief when acting to turn the head 
toward the opposite shoulder. Behind its inner border lies the pneumogastric 
nerve, in the same sheath with the common caratid artery and the internal 
jugular vien. The common carotid artery runs as far as the upper level of the 
thyroid cartilage, where it branches into the internal and external carotids; its 
course corresponds to a line drawn from the sterno-clavicular articulation to a 
point midway between the angle of the lower jaw and the mastoid process. 
Note the interval between the sternal and clavicular origins of the sterno- 
mastoid muscle. Just behind this interval lies the common carotid artery in- 
ternally, the external jugular vein externally. Between them, and a little pos 
teriorly, lies the pneumagastric nerve. The sterno-clavicular joint is important. 
Behind it lies the commencement of the vena innominata. It is the level of the 
division of the innominate artery on the right, and the level of the apex of the 
lung. As to the apex of the lung, it may rise one and a half inches and per- 
haps two inches above the sterno-clavicular joint. This is the part of the lung 
which is least apt to be inflated with air, and hence very apt to be the seat of 
disease. I have already called your attention to its examination by percussion 
at the sternal end of the clavicle. The subclavian artery is also important. In 
the supraclavicular fossa, just at the outer edge of the sterno-mastoid mucle, 
about an inch above the clavicle you will feel the pulsation of the subclavian 
artery at that point it crosses the first rib. Pressure slightly downward and 
inward there will impinge upon the subclavian artery, a little pressure is suffi- 
cient. As you know, the outer border of the sterno-mastoid muscle corres- 
ponds nearly to the outer border of the scalenus anticus muscle, and that across 
the scalenus anticus runs the phrenic nerve. Now, at about the point where 
you impinge upon the subclavian artery you will also reach the phrenic nerve. 
In fact, the way Dr. Harry Still often treats hiccoughs is b}^ standing behind 
the patient and placing bis thumb along the outer edge of the sterno-mastoid 
muscle and thus reaching the phrenic nerve. Deep pressure at the upper part 
of the supraclavicular fossa will reach the transverse process of the seventh 
cervical vertebra. In a long thin neck it is stated that just above, and nearly 
parallel with the clavicle can be felt the posterior belly of the omo-hyoid mus- 
cle, as it rises and falls in inspiration. 

III. I wish to continue the examination of the neck. There were a cou- 
ple of points that I should have noted in going over the spine, but they slipped 
my mind at the time. One of them is how to stretch the quadratus luniborum 
muscle. This muscle in various cases will become contracted and will then 



76- KxAiMEN^ATliON OF TUB' M^C!^. 

draw d©wn the lower rib, and may make coiasiderable trouble. I have fouad 
that I could treat a lame back in that way and get results ths^t I could get in 
no other. Frequently the lameness there is between the fifth lumbar and the 
the sacrum. And why? Because the traction in the quadratus lumborum 
muscle is drawing the pelvis up and is bringing a strain at the point of 
junction of the fifth lumbar with the sacrum, I have often removed lameness 
there b}^ stretching that muscle. It takes a diagonal pull to stretch the 
quadratus lumborum properly. If I have an assistant I have him draw on the 
pelvis while I draw the arm in the other direction. I draw steadily, but do 
not jerk, and I put a considerable force of traction upon the part. Then I have 
my assistant take the arm, and I stretch in the other direction, and in that way 
I get a pull upon every part of the quadratus lumborum muscle. 

The other point concerning the spine was, that you will in passing your 
hand over the back, frequently detect changes in temperature. You will find 
a warmer spot, or, more frequently a cold streak following the distribution of 
the inter-costa] nerves. That is quite an important method of diagnosis. You 
should accustom your hand to detect differences in temperature. Of course 
that has to be done next to the skin. When you find that, of course it indi- 
cates at once that the blood supply is not equally distributed, and that proba- 
bly there is a lesion along the spine at the point where the cold streak leaves 
it. If you find it hot it may mean the same, but we do not find that as often 
as we do the cold streak. 

In the consideration of the neck I have divided it into, first, the throat, 
which I considered at the last lecture; second the neck proper; which I shall 
consider at this time. I have alread}" noted the spines and the peculiar verte- 
brae, and the fact that you can note the dislocated vertebra sometimes by an 
examination in the pharynx by means of the finger. I have called the atlas to 
your attention and the fact that 3^ou must turn the head from side to side in 
attempting to examine the transverse process of the vertebrae. In a case of 
fracture, which we may possibly find, there will be crepitus and abnormal mo- 
bility of the parts. You should in your examination of the neck look at the 
condition of the superficial and deep muscles. Carefully examine to note any 
hardening of the muscles. The hardening, of courrse, may be in the superfi- 
cial muscles or in the deep muscles; you will have to judge as to where you 
think the tightening of the muscle is. Examine very carefully all about the 
superficial and deep muscles. It is usually in the throat that you find the su- 
perficial muscles contracted, and the deeper ones, in the neck further back. 
The sterno-mastoid muscle of course always comes prominently to your atten- 
tion. It is contracted in cases of torticollis; or it may be hardened and produce 
pressure upon the structures beneath it. Then examine the scaleni muscles. 
You know how they are attached, reaching all the way from the second cervical 
down to the seventh, then running to the two upper ribs. Normally these mtis- 
cles- will feel rather hard, you will become acquainted with the normal feeling 
of tkem. They aiie significant to us irom the fact tliat they sometimes become 



KXAMINATION OP TH^ NECK. 77 

contracted and bring traction upon the upper two ribs. Hence it is that any dis- 
placement of these upper two ribs is very likely to be upwards. This will 
cause heart trouble, or lung trouble, etc. These muscles are useful in replac- 
ing ribs which are dislocated. I have already noted the ligamentum nuchae; 
how you may find it and how you may treat it. The neck is about as good a 
place as there is for the Osteopath to find sore spots. Principally you are lia- 
ble to find them in the fossae just below the occipital bone. In fact, I have 
been told that it is always naturally sore there, but I don't believe it, because 
I find lots of cases that are not sore there at all, and I think that in the normal 
neck there is no soreness there. Of course you may impinge at any time upon 
a nerve hard enough to hurt it, but I am speaking of examinations not of chop- 
ping wood. Why these sore spots occur is hard to say, but I think the sore- 
ness is due primarily to the condition of the great, and sub-occipital nerves which 
you find at that point. I do not think that it is just because you touch them, 
but they were sore before you touched them. Then you will often find that 
just below the occipital protuberance there is a sore spot; and just there you 
will often find a tightening of the ligaments. The lesion is important because 
if you find a sore spot there or in the fossa below the occipital bone you are led 
to believe that there is some irritation affecting the sub and great occipital 
nerves, and since they are in close connection to the superior cervical ganglion 
of the sympathetic they may have an affect through it upon the distant parts 
of the body. You should also examine in the region of the three ganglia of the 
sympathetic. The superior cervical ganglion opposite the second and third 
vertebrae on the rectus capitis anticus and major muscle. The second cervical 
ganglion lies opposite sixth and seventh cervical vertebrae. While the inferior 
cervical ganglion lies just below the seventh cervical vertebra, and is frequent- 
ly coalesced with the first thoracic ganglion of the sympathetic. Quain puts it 
that this inferior cervical ganglion of the sympathetic lies just over the costo- 
central articulation, that is, the articulation of the first rib with, the spine. 
Now, if you should find lesions in those places they are, of course significant to 
you according as they may affect the sympathetic life of the individual. They 
may affect the brain, heart and lungs, or any distant part of the body. Also 
remember the distinctly spinal nerves here, those of the cervical and brachial 
plexuses. Impinge upon these nerves where they pass out between the scale- 
nus medius and scalenus anticus muscles, and, upon deep pressure the patient 
will tell you he can feel pain in his shoulder and arm. You should also here 
look at the temperature of the parts yon are examining, and I think that no- 
where else in the body we as frequently find a cold place as in the back of the 
neck. I thought that perhaps it was because it was moie exposed, but I doubt 
that very much because I have treated patients who had been in the house for 
hours; and those muscles were cold. I have treated patients in the heated per- 
iod of summer when certainly there was not any chance of there being expo- 
sure to cold, and the temperature was abnormally low. That argues to your 
mitwl certainly that there is some inequality in the distribution of the blood 



78 LESIONS: PRESSURE BY EXUDATES, ETC. 

flow, it may be a tightening of the muscles upon the blood vessels, but it shows 
you, at any rate, that there is probably the seat of the lesion. In this exami- 
nation you must look at the condition of the blood supply to the throat through 
the neck and thus to the brain, which is important, and you should be very 
sure that the blood supply to the neck and brain are normal. 

Q. You spoke of treating the phrenic nerve above the clavicle. Could it 
not also be reached from the second to to the fifth cervical? 

A Yes sir. Dr. Harry Still frequently works right along the third, fourth 
and fifth cervical. The phrenic nerve arises from the fourth, also partl}^ from 
the third, and having a connecting branch from the fift i. So we work at the 
anterior edge of the scalenus medius and impinge upon the nerve by pressing 
backward against the transverse processes of the vertebrae. 

Q. Do you use the word lesion for au}^ abnormality about the body? 

A. I have used it for an injury. Taking it in its generic sense it means 
injurv. There is a difference, perhaps, in the use of that word, but we here 
use it in the sense of an injury. That is the use I have heard made of it ever 
since I have been here. 



LECTURE XIV. 

At the last lecture, I considered briefly, possible lesions of centers. I 
shall carry that idea further to-day. What I took the most time to explain 
was how thickening the connective tissue of parts might lead to impingement 
upon blood vessels or upon nerves, showing that, in the first place, there 
might be an irritation caused by a slip of a vertebra, thus setting up inflam- 
mation, this followed by formation of new tissue which has a tendency to con- 
tract. I showed that the same thing could follow hyperemia. Such things, 
then, are significant to the Osteopath, since they act as obstructions to the 
flow of blood and nerve force. Such lesions may, if not prevented, go much 
further, resulting in bon}' aukoylosis of joints or in ossification of ligaments, 
thus setting up a permanent deformity. It is then then the function of the 
Osteopath not so much to treat that deformity, as to prevent it. That is, in 
such case his treatment is prophylactic. 

I then called your attention to landmarks in the neck, and to certain, 
points in how to examine the neck. 

I. Theory of Work Upon Centers. (Continued.) — Further possible 
lesions. You may have a pressure upon important parts bv exudates or bj^ 
oedema. An exudate is in nature fluid or cellular, and it follows pathological 
processes in the nature of inflammations or hyperemia. Having an inflamma- 
tion, you have an exudation of the contents of the blood vessels, those con- 
tents are fluid, or in the later stages of the exudation, cellular. They thus 
may, at any place, and do, build up a considerable thickening among the tis- 
sues, acting as a mechanical pressure or irritant upon important parts. These 
important parts may be blood vessels or nerves. Byron Robinson says "The 



THEORY OF CENTERS. CERTAIN I^ESIONS. 79 

nerves may suffer from pressure by exudates or oedema, congestion or from 
malnutrition. The final outcome is derangement of the nerves, exaltation of 
sensation and motion, or debasement of sensation and motion." He was 
speaking there particularly of the nerves to the bowels. The Osteopath's duty 
in relation to such things is that he must, in making his diagnosis, take into 
consideration the probability of there being such a lesion present. You will, of 
course, in your further studies which will include pathology and other im- 
portant things, learn how to recognize these lesions better than I can tell you 
here. What I propose to do is to use these things to illustrate the subject of 
Osteopathy, but I cannot of course go into detail and explain everything in 
pathology that I come across, but they are valuable to you, and you will recog- 
nize their importance when you come to that place in your course. In general, 
you will recognize or look for the process of oedema in patients with lung, 
kidney or heart trouble, you will be very apt to find it in such cases; or in cases 
where there is obstruction to the blood flow. It may be mechanical shutting 
down upon an artery, or it may be a narrowing of the lumen of a vessel from 
some disease, or something of that kind. The Osteopath must judge what 
may be the cause and work to remove the lesion. As to hyperemia, and its 
effects upon the cord, I have already shown this to you in a quotation from 
Green some time since, where he said it caused paraesthesia of sight or hearing, 
or perhaps even spasms. But according to Robinson, this hyperemia may act 
mechanically to affect not centers only, but directly to affect nerves through 
pressure. Your lesion may be malnutrition, but I will notice that later. 
Other lesions which may produce pressure upon important parts are deposits or 
growths. I wish to quote from Dr. Jacobson, Dr. Hilton's editor, where he 
says: "Sensations of sharp pains like knives around the trunk, increased by 
movement, and a numbed feeling about the body, may be produced b}^ gum- 
matous meningitis making pressure upon the posterior roots of some of the 
spinal nerves." You note here that the pathological processis an inflammation, 
that secondarily there is set up a pressure as the result of that inflammation, 
which is a gummatous deposit, thus it acts as a lesion producing pressure. 
Hilton instances a case, further where there was pressure upon the ulnar nerve, 
causing much numbness, lack of sensation, and particularly of motion, in the 
third and foruth fingers. They became discolored, and finally gangrenous. 
(Gangrene is death of tissues.) Upon examination there was found an ex- 
ostosis, an outgrowth from the bone, upon the first rib, pressing upon the 
ulnar nerve and the subclavian artery, thus shutting off the nerve and blood 
supply partly, the nerve more fully. However, shutting oft' the nerve supply, 
alone would have been sufficient to cause degenerative changes in the part 
affected. 

I wish to call your attention to this structural degeneration by pressure 
upon a nerve. Thus, you may have pressure in the form of a foreign growth 
or in the form of some excresence upon important parts. Further, your lesion 
might be an aneurism, and might bring pressure upon parts. Green states 



8o THEORY OF CENTERS, CERTAIN LESIONS. 

that ''active congestion follows pressure upon the sympathetic, as for instance 
in the neck b}' an aneurism," Thus you may inhibit vaso tonic action of the 
svmpathetic and cause hyperemia, or vice versa. 

Another kind of lesion v^'hich will frequently come to your attention is 
tumor, which you will notice also is of such a nature that it produces pressure 
upon important parts. You might take, for instance, the case of ex-ophthal- 
mic goitre: there you have protrusion of the eye ball due to a deposition of fat 
behind it. That shows an over stimulation of the trophic fibers to that part of 
the head. There are also cardiac symptoms, palpitation and irregularity in 
the beat of the heart, which shows an interference with the cardiac nerves, the 
sympathetics receiving pressure from the goitre in the neck. And further, 
you have vaso motor s^^mptoms from the pressure of this goitre, because 
3'ou frequentl}' have a flushing up of the cutaneous circulation. This is a good 
example of what mechanical pressure maj^ do to influence nerve life. Robin- 
son also instances the case of an abdominal tumor leading to fatty degeneration 
of the heart. The impulse sent from the tumor up along the abdominal sj^m- 
pathetics to the solar plexus, here it is reorganized, perhaps sent to the cervi- 
cal sympathetics, down the cardiac branches to the heart, resulting in irritation 
of the heart, causing the heart to over feed itself, which finally results in 
h^'pertrophv. followed by fatt^- degeneration. Thus 3'ou can learu to trace the 
causes. Almost any young Osteopath would treat that efi'ect, heart trouble, 
when really it is the tumor, far removed from the heart, which is the cause of 
the trouble. In speaking of abdominal tumors, Robinson says: "The irritation 
from the tumor is carried on the plexus of an}- contagious viscus to the abdo- 
minal brain, where it is reorganized and emitted to the digestive tract over the 
gastric plexus, the superior mesenteric plexus and the inferior mesenteric 
plexus. In kny case the brunt of the forces end in the ganglia which lie just 
below the mucous membrane. The ganglia constitute what is known as 
Meissner's plexus, which rules secretion. If the irritation be of such a nature 
as to produce excessive secretion, diarrhea may result; the excessive secretions 
will decompose and induce malnutrition." Thus one difiiculty leads to another. 
You might have constipation, indigestion and various troubles. He goes on to 
sa3^ that small tumors on pedicles so that they may swing around, and roll 
about, and pound upon the abdominal structures are those which are most in- 
jurious, for obviously, if the tumor is fixed, it will not irritate much, but if it 
rolls about and is quite movable it will keep irritating the sympathetics and 
aggravating the trouble. 

The lesions given above are the lesions which produce pressure in the 
bod}', pressure upon important structures, for the most part nerves. 7 have al- 
ready in m3" lectures noted certain results that 3'ou would get from pressure 
upon nerves, for instance, irritation, stimulation, inhibition, hyperemia, anemia, 
etc. But I wish to go further today and show that the result may be more ser- 
ious than a mere inhibition or stimulation, that it ma}^ lead to degeneration of 
the ner\'e fibers. Thus there would be processes of deterioration of the struc- 



THEORY OF CENTKRS. OERtTAIN I^KSIONS. ;8l 

ture of the parts, especially the nerves affected. The process of degeneration 
of the neives is about as follows, and is called secondary degeneration, since it 
is -secondary to some primary lesion; it is also called Wallerian degeneration. 
The first process is that the myelin becomes degenerated, the sheath of 
Schwann becomes separated into two parts, still later it becomes granulated, 
and finally disappears from the nerve sheath, perhaps by the process of saponi- 
fication, as has been stated by some writers. During this process the axis- 
cylinder, which is the important part of the nerve, is segmented, broken down 
and removed in practically the same way. Thus you finally have nothing but 
the nerve vsheath left. The nerve has then lost its conductivity and is useless 
as a nerve. What I wish to show is that pressure upon nerves may be bad 
enough to induce this degeneration, which you can readily see is a serious re- 
sult. Gowers says: "Degeneration follow^s many slight lesions of nerves, 
compression, over extension, and the like." He says further tjaat it is prob- 
able that a compression for a few hours has such an effect in separating the 
molecules in the white substance of Schwann as to set up a secondary degener- 
ation of the same character as that resulting from division of the nerves. This 
pressure does not need to be severe; it may not extend over a period longer 
than a few hours to produce finally all the results which the Osteopath meets 
in his work. Pressure of some dislocated part or pressure of some such lesion 
as I have mentioned today upon nerves, interferes with the sense of feeling and 
with structure of other parts, and may have a similar effect to cutting the 
nerve. Gowers says that after division of a nerve or degeneration of its fibers, 
there is a marked change in the muscles supplied by the motor nerve. This 
is a change vv^hich is a deterioration of their structure. 

So much, then, for lesions which may be brought on by pressure. You 
have seen from what I have said what this pressure may result from. I wish 
to call your attention to the fact that the action of muscles may in certain cases 
become traumatic, wounding a nerve, and setting up serious results, often de- 
generation. Gowers, speakmg of neuritis, says: "Nerves are sometimes dam- 
aged by a violent contraction of muscles through which they pass. It is prob- 
able, also, that muscular action excites neuritis in other situations, especially 
in persons who are predisposed." Also we may notice the indirect result of 
traumatic lesion by action of the muscles. 

Byron Robinson, in speaking of peritonitis says: "Peritonitis is due to 
two causes, (of which I will name one) viz., traumatic muscular action of the 
psaos magnus on the sigmoid, and traumatic muscular action of the lower right 
limb of the diaphragm on the descending colon." The w^ay by which the nerves 
there are involved is this: That that injury allows the migration of pathogenic 
bacteria, which set up peritonitis, thereby crippling the nerves, and perhaps 
-causing considerable degeneration of them. And this traumatic lesion, direct- 
ly by action of muscles upon nerves, or indirectly as in this case, is an impor- 
tant thing to the Osteopath, and he must take it into consideration in diaguos- 
ling his^cases. You will learn later that these nerves when degenerated, may, 



82 TREATMENT OF THE NECK. 

by appropriate treatment, of which rest and quiet is an important part, be re- 
generated. 

To illustrate the results of pressure, take a case of which Dr. Hilton 
speaks; being a case of fracture of the radius. The callus, in the growing to- 
gether of the bone, had pressed upon the ulnar nerve above the wrist, and 
there had resulted, not a paralysis, but an ulceration upon the skin of the 
thumb and first and second fingers. He also notes a case which pressure of 
the humerus upon the brachial plexus has resulted in a wasting of the deltoid 
muscle by insufficient nerve supply from the circumflex nerve, which had been 
impinged upon. That emphasizes the importance and necessity of taking into 
consideratian everything which may bring pressure upon parts. 

Your lesion, as I have stated, may be malnutrition. I have already ex- 
plained that to some extent. Anemia may aflect not only centers in such cases 
but it may affect nerve fibres directly, or the malnutrition may be from a poor 
quality of blood. 

The question comes to you, what can an Osteopath do in such cases? Can 
he remove exotosis, anuerisms, and such things as that? No, he can not. If 
you have a case of exostosis, it is a surgical case and you will have to send it to 
a surgeon. Aneurism has usually to be treated by surgical means. I have 
called these things to your attention on account of their importance, and to 
lead 3^ou to be on your guard. You should not take secondary symptoms and 
treat them. Be on 3^our guard alwa3^s in making your diagnosis. Some of 
these lesions you may remove of course, such as the exudates in hyperemia 
or inflammation, or the gummatous tumor in meningitis, also the goitre press- 
ing upon the sympathetic. All these things are subject to your treatment. 

II. How TO Treat a Neck: — I have called your attention to how to ex- 
amine the neck. I wish to say to you that it is an extremely important thing 
that you treat the neck carefully, for the treatment of the neck, more than any 
other part of the body, is to be done with great care by the Osteopath. As in 
the consideration of the examination of the neck, I first take up the throat, so 
in the treatment I will notice that part of the subject first. In treating the 
throat your first duty is almost always to note whether there be a contraction 
of the hyoid muscles, and if such be the case to relax them, as that leaves a 
fiee field in which to work, since they may mask other troubles which you may 
not notice without having that removed first. You technique of manipulation 
must be carefull}^ noted, and the degree of force which you exert, because there 
are important structures which you may injure by rough pressure. The best 
way is to use the flat of the hand; the cushions of your fingers. To relax the 
muscles here the best way is to push the head toward the side, that is away 
from you, while drawing the other hand towards you. You do not have to rub 
your fingers over the neck as though your fingers were a file. Draw the muscles 
with the fingers, do not let them slip over the surface, but hold against the 
muscle and draw them toward you. You can do this work as thoroughly as 
possible without anj^ rough rubbing at all; necks are readily chafed sometimes^ 



TREATMET OF THE NECK. 85 

and if you wish to save the patient to your practice you will have to be a little 
careful how you handle his neck. 

Next as to the tonsils. When you find an enlarged tonsil and wish to 
treat it, the first thing to do is to loosen the muscles over the blood supply to 
the tonsil, which is from branches from the carotid arteries. Hence, if you 
have relaxed all the muscles about the tonsils both internal and external, so 
that there is no further impingement upon the blood supply then you have re- 
lieved the lesion. Of course if the lesion is back in the neck causing the nerves 
to shut down on the vaso-motor supply you must attend to that. However, 
generally we work directly in this way. Give it a thorough treatment, but 
not too hard. Work along the angles of the jaw, and then work all down 
along the course of the common carotid artery, down as far as where the artery 
comes from the thorax just behind the edge of the sterno-mastoid muscle. 
That should be done thoroughly; you should not be in a hurry. Further, I 
always put my fingers in behind the clavicle; be careful in putting your fingers 
there not to hurt, because it is a very tender point. I always put my fingers 
in there and then approximating the bent arm to the face press it on above and 
over while my fingers lie between the clavicle and the first rib. This relaxes 
everything; then bring the arm down over the head, outward and downward; 
this will stretch the parts and stimulate the flow of blood through the carotid 
artery. Perhaps the chief value of that movement is this: We frequently find 
that the muscles about the upper part of the thorax are drawn and are making 
some impingement upon or stoppage of the blood flow through the carotid ar- 
tery, and you simply give it freer action by the motions you use there. We 
also frequently stretch the jaw, as we call it. I put my fingers just below the 
inferior maxillary bone, placing the thumbs above, usually about the molar 
process, then holding fairly tight spring the mouth open, rubbing downward 
as the mouth opens to relax the muscles. That should be done three or four 
times. It is not a bad idea to simply hold the jaw firmly and tell the patient 
to open the mouth while you are holding, and that will stretch the muscles 
about the part. Of course, in treating any part you must watch its blood and 
nerve supply. We have mentioned the blood suppl}- in this instance. The 
nerve supply is from the pneumogastric, and from Meckel's Ganglion of the 
fifth. You can stimulate the pneumogastric at its exit from the skull by deep 
pressure. You can also get an effect upon Meckel's ganglion bj^ having the 
patient open his mouth, and thrusting the fingers into the glenoid fossa, have 
him close it again. It will usually hurt, but it is supposed to have an effect 
upon Meckel's ganglion, which I will show later when I tell you how to treat 
the neck. The point there is the communication of the symathetic with the 
pneumogastric and with the fifth and with the blood supply about the tonsils. 
Thus you have treated both the nerve and blood supplv in treating an enlarged 
tonsil. If your diagnosis has shown you a tender point just below the angle of 
the law, as is stated to be the case in catarrh, the best way to attend to it is 
by the means already given, viz., relaxing all the parts. In that way you will 
throw fresh life there and take away the pain and tenderness. 



84 TRKATMKNT OF THE NECK. 

, Should you find lymphatic glands enlarged it is a mistake to go at them 
and treat them directly. If they are enlarged it is from some reason. You 
will sometimes find them enlarged in tonsilitis or in diphtheria, and they are 
enlarged because the}" have work to do as scavengers, and 3^ou must look to the 
original cause. I do not think it admissable ever to work directly upon those 
lymphatics, thinking that that will take down the enlargement, especially in 
acute cases. It may possibly do in chronic cases, but in acute cases I have 
known of injury being done by rough treatment of enlarged l3^mphatic glands 
when the trouble was somewhere else. 

Q. In the case of tonsilitis, would you not stimulate the blood away from 
the tonsils? 

A. When you have stimulated the arterial supply, you will sweep away 
the congestion. Whenever j^ou have attended to the nerve supply there regu- 
lating the blood, the vaso-motors, of course then you get the same effect, it all 
tends toward the normal and to restore the circulation as it should be. 

Q. Increasing the arterial flow will sweep away the condition? 

A. Yes, that is the tendency, that is how you can affect congestion 
through blood supply, but do not forget to couple it with nerve supply, vaso- 
motor. 

Q. I thought the way to get at it was to drain the congested part by 
venous withdrawal. 

A That comes partly through 3'our vaso-motor effect, but if you can get 
sufficient "vis a tergo" to sweep that all out, that is all you need, and that is 
readily done. 

Q. Do you always have a local edematous condition with inflammation? 

A. I do not know that there can be an inflammation without edema — 
without an exudation; that is one of the important symptoms of inflammation. 

Q. Do you treat the sympathetics for goitre? 

A. The cervical ganglia all three of them, I would treat, but would es- 
pecially direct my attention to loosening the anterior and posterior muscles, 
with the idea of relieving all parts and allowing a free flow of blood and nerve 
force. Of course you must do here, as you alwa^^s do, look for the lesion. 
You may find the clavicle is slipped, or you may find that one of the vertebrae 
is displaced — it depends upon the cause. 



LECTURE XV. 

At the last lecture I considered, under the general subject of theory of 
work upon centers, further lesions that you might meet in your work. That 
you might have pressure b}^ exudates or edema; that the exudate might be fluid 
or cellular; that the Osteopath must take into consideration the possibility of 
such lesions and be on the lookout for them, thus going into the history of the 
case. For instance, if there is a history of inflammation, you will look for 
such a possible lesion, or if a history of congestion, you will look for that lesion. 



GKNERAI^ CONSIDERATIONS. 85 

The lesion ma}^ be a congestion bringing pressure upon parts, or it maybe mal- 
nutrition; it may be some kind of a deposit, for instance a gummatous deposit, 
of which I instanced a case; the pressure of the gumma upon the posterior 
roots of the nerves, where they emerge from the spinal column. I spoke also 
of an exostosis, or growth from a bone; the lesion may be an aneurism bring- 
ing pressure upon the sympathetics; or it may be some kind of a tumor, as in 
the case of exophthalmic goitre. I then quoted from Robinson to show what 
the effect of such lesions might be. I went further to show that the result might 
be more serious than mere stimulation or inhibition of nerve force, showing how 
it might cause accual degeneration of the nerves and paralysis of the parts sup- 
plied. I showed you how such degeneration might be accomplished by 
the traumatic action of contraction of muscles. That although the Osteopath 
was not able in every case to remove these lesions, he may prevent their form- 
ing, or he may be able to recognize the presence of such lesions and send the 
patient to a surgeon if the case required surgical interference, without himself 
bothering with them. 

I. Gknkral Consider ations. — There is a question that sometimes 
arises in the mind of the Osteopath, as to what the effect of stimulation or in- 
hibition will be upon parts which he is not attempting to affect, but which are 
connected directly or indirectly with the parts on which he is working. In 
other words, will he thus stimulate or inhibit other important parts of nerve 
force, and thus, you might say, vset up a pathological result, and his treatment 
result in certain pathological processes which were not intended? Every once 
in a while a patient will say to you, such and such a thing happened after your 
last treatment, and do you think that your treatment could possibly have led 
to such and such a trouble? If you are perfectly sure that the action of your 
treatment upon surrounding parts is not such as to produce pathological results, 
you will often be able to answer him strongly in the negative, when otherwise 
he would think you to blame for something that happened. You will frequent- 
ly meet cases of that kind. I have had a number of such questions asked me. 
When considering probability, remember that the tendency is always toward 
the normal, and that helps you much, unexpectedly as well as expectedl}^ some- 
times, not only where j^ou remove a lesion and depend upon nature to tend to- 
ward the normal to restore things as they should be, but that the manipulation 
that you make upon an affected part tends to restore that part to normal, while 
a manipulation that you make upon the parts associated does not tend to the 
abnormal of those associated parts at all, but that the effect upon them is simply 
what might be compared to the effect of normal exercise. So you need not 
be afraid of producing pathological results in that way. For instance, we have 
to treat the pneumogastric in a case where the liver is not acting properly, and 
the intestines seem to be lacking in stimulating force. Part of our treat- 
ment in such a case would be directed to the pneumogastric nerve, since it has 
to do with these viscera. Now, the question is, whether by stimulating, or in- 
hibiting, or treating those nerves you would also have an effect upon the lungs 



86 WORKING AGAINST THE RESISTANCE. 

and heart, which are supplied by the pneumogastric nerves, an effect which 
would be bad. Such has not been the experience at all, and you are not in 
danger, in treating the pneumogastric in such a case of having a bad effect upon 
the heart and lungs, supposing them to be normal, because your treatment 
tends to restore the abnormal intestine and liver to the normal, while it tends 
simply to have the effect of exercise upon the other parts, and there is certain- 
ly nothing bad in that. Again, you might have a case in which the splanch- 
nics were involved, and one who was very careful over questions of theory 
might want to know whether treating those nerves would have a bad effect up- 
on the kidneys. Experience shows that such would not be the case. Or, for 
instance, in the case of eye trouble, you frequently find that the terminal' 
branches of the fifth nerve, emerging from the supra- orbital foramen, are very 
tender to the touch, probably on account of a secondary lesion there, abnormal 
impulses coming from that nerve terminal causing the parts about the foramen 
to contract and impinge upon the nerve, thus keeping it tender. That may be 
the cause of it. Now, of course in treating there you simply remove the con- 
traction about the parts, you stimulate the blood vessel and the nerve, and re- 
move the soreness. You would not he afraid of interfering with the nutrition 
of the eye, which is innervated b}^ the fifth nerve. 

This will serve practically to explain the effects obtained by those who are 
not entitled to the right to practice Osteopathy, certain of those who have seen 
the pecuniary benefits of Osteopathy and gone out without proper equipflient, 
and have become what the "Old Doctor" calls "engine wipers," and I presume 
others who have had better opportunities may work in the same wa3^ That is 
they work all over the patient, and work pretty near half an hour, so the pa- 
tient will think he has had a good treatment, so that if there is a place to be 
treated he will be'^sure to hit it. That is the way the Osteopathic quack works 
in most instances, taking into consideration that the effect is toward the nor- 
mal, he gives a nice stimulating treatment all over the body, and if he strikes a 
few lesions thej^ may be helped, as the tendenc}^ is toward the normal. That 
will explain how he happens to get results in some cases. Then, our work is 
to remove the lesion, and not to be afraid that we will disturb the normal con- 
ditions. 

Further, concerning work upon abnormal parts, it is considered as a prin- 
ciple in our practice that we should work against the resistance we meet. That 
is a little hard to explain, and it is not a principle which will apply as general- 
ly as some others. That is, move the part in the direction in which you will 
cause the unnatural tension to appear. Because if by moving the part in a cer- 
tain direction, as for instance, flexing the limb, you find that there is an un- 
natural tension opposing the normal movement, you then see you have a lesion 
with which you are dealing, and in working against the unnatural tension you 
are working against the lesion, at least in some cases. This, then, becomes a 
method of how to work to remove certain lesions. Dr. Harry says he always 
''springs the part, "as he expresses it, in the direction to cause the most pain. 



STIMULATION AND INHIBITION. 87 

Frequently you will find that the manipulation that you put upon a part will 
be diagnostic in part, and that it will often reveal to you certain lesions of the 
kind I have described. Remember, that in such cases your cue is the pain 
that you find. For instance, I might find a contraction in the pyriformis mus- 
cle in case of sciatica. The cause frequently of sciatica, from our standpoint^ 
is a contraction of this pyriformis muscle in such a way as to impinge upon the 
sciatic nerve, which runs under it. So that you will then have an abnormal 
tendency to external rotation of the head of the femur, and the movement that 
we adopt is of such a nature as to stretch the pyriformis muscle. The same 
thing is seen in stretching the ligamentum nuch^, or the stretching of the 
sterno- mastoid muscle. I have seen cases in which that muscle was stiffened 
and contracted, in wry neck, and the treatment was to stretch the muscle. 
This will illustrate what I mean when I say to work against the resistance 
which you will find, and that that is a cue to the lesion itself. Of course that 
may not be a primary lesion, it may be a secondary lesion as in the case of the 
sterno-mastoid, the primary lesion may be something affecting the vSpinal acces- 
sory which innervates that muscle, but at any rate it has set up a certain trou- 
ble which must be corrected. That is not, as I said, a general principle; you 
cannot apply it everywhere; it applies especially to parts which may contract 
and thus form obstructions. Do not be too eager in carrying out this idea, be- 
cause you may irritate the parts. In trying to get the cue you may do harm; 
I have seen that done. 

In the removal of lesions the question of stimulation or of inhibi- 
tion becomes secondary, since the lesion being removed, nature tends 
to the normal. Nevertheless, there come times in our practice when 
we must either stimulate or inhibit according to the rules laid 
down. As for instance, after we have removed the lesion and 
we have still to treat the parts to strengthen them, the question 
arises once more, what shall we do in this case, stimulate or inhibit, so that our 
work is not entirely confined to the removal of lesions. Sometimes the lesion is 
not apparent, and we simply have to go to work at the innervation of the parts 
and get the results that we desire, either by stimulation or by inhibition. The 
disease may be of such a nature that this will be the rational method of treat- 
ment. Not that we should not look for lesions always, but sometimes we have 
to get to work directly upon the nerves. For instance, in diarrhea or flux, 
their abnormality must be of nerve fore?, it frequently happens that we simply 
have to treat that case by strongly holding the spine, that is, inhibiting the 
sympathetic nerves, even though we mav not at that time correct some lesion 
in the spine. I frequently simply inhibit strongly all along the lumbar region, 
and I certainly did nothing there but inhibit nerve action. In obsteteric the 
parturition center is stimulated at certain times to cause the contraction of the 
circular fibres of the uterus; we are not removing a lesion in that case, we are 
stimulating to bring about the desired end, and are working upon the nerves 
which control those muscles. In some headaches we cannot find any particu- 



88 STIMULATION AND INHIBITION. 

lar lesion; we very frequently go to the sub-occipitals and hold them and inhib- 
it them there — the sub and great occipitals; in that case we have inhibited. In 
the case of epistaxis we must simply stimulate in the neck; or in the case of 
hiccoughs, which is a very good example, we often do nothing but go to the 
phrenic nerve and inhibit it by pressure upon it. So I think the point is well 
taken, that we must sometime stimulate or inhibit without removing lesions, 
either after removal of lesions, or in the absence of discoverable lesions. That 
then brings up the point that there must be some different movement which 
we employ to stimulate or inhibit. The difference in stimulation and inhibi- 
tion is well illustrated by a simple phenomenon — a very slight touch over dif- 
ferent parts of the body will cause a tickling sensation, which ma}^ become al- 
most unbearable; whereas a firm pressure at the same place simply removes the 
conductivity of the nerves, or inhibits. The other was a stimulation. In gen- 
eral the movement used to inhibit is a holding or pressing motion; I will show 
you that later; a holding or pressing motion, having as its end in view the 
idea of quieting the excitability of the the nerve, that is, the lessening of its 
conductivity, which we know is done by pressure. We have seen that to be a 
fact according to the authorities. Thus, in that pressure upon the phrenic 
nerve we quieted the spasm of the hiccough. In general, alternation of pres- 
sure and a relaxation of pressure, is used to stimulate, the idea being to excite, 
to tittillate, and this is comparable to the "making and breaking" of an electric 
current. We use alternate pressure and relaxation, and the idea is to in that 
way arouse nerve force. For instance, in a case of nose bleeding we have to 
rub the superior cervisal ganglion, and thus stimulate the tonicit3" of the blood 
vessels. In stimulating we work frequently along the spine, giving a stimula- 
ting treatment, described b}^ one as working hard and fast, making and break- 
ing. We simpl}^ keep working in that way. We do not adopt the pressing 
motion, what we use is a quick, stimulating motion. At least that is the Os- 
teopathic view of how we stimulate or inhibit. That is the technique of mani- 
pulation: Perhaps I do not fully agree with all the physiologists say on the 
subject of stimulation or inhibition, but I think I have shown that we have a 
pretty good allowance of authority, from quotations made, and that is the way 
we get results. This, then, would naturally bring us to consider the question 
of the degree of force that we should use. It is certain that you can stimulate 
so assiduously that you can get the opposite result, and finally inhibit instead 
of stimulate. The secret of it is that stimulation must amount to irritation, 
which if performed too frequently or too hard will, after it has run its course 
result in the nerve refusing to respond to the usual stimulus, and finally to res- 
pond to any stimulus if the irritation is carried far enough. So that stimula- 
tion may become irritation, and finally inhibition. 

You must remember in treating a jDatieut to adapt the degree of force to 
the end in view\ This refers not only to the treating of a case, how hard to 
treat at the time, but the treating of a case too often. I wish you could all 
heard what Dr. Conner said yesterday concerning the practice outside. He 



GENERAI, CONSIDERATIONS. 89 

said a great many cases have to be treated too often. A patient comes into 
your office, and yon tell him, "I want to see 3^ou not more than once a week, 
in your case I can do you as much good in treating you once a week as I could 
treating you three times a week or every day." And that is a fact, but the 
patient wants to get all he can for his money; he says, "You are charging me 
twenty-five dollars a month, and I think I ought to get more than four or five 
treatments, that makes it come pretty high, and I would like at least two 
treatments a week." And it is almost impossible to prevent treating too fre- 
quently, but when you do of course you are in danger of irritating. As I say, 
you must explain to the patient that by treating so often you irritate these 
nerves and structures and thus keep up an abnormal irritation instead of re- 
removing it. You might also say that it is not you who cures, but Nature 
cures; 3^ou simply aim to assist nature. Now, if you should treat so often, tell 
him you do not give Nature time enough between times to work, and that you 
do not think it best. You have to learn these arguments that apply to such 
cases, as you will meet them frequently. When you say to nature that you 
will aid her so much that she does not have to work at all, she finally gets 
tired of the effort and simply "lays off" and lets you do what you can. We 
had a case in Chicago of neuralgia of the fifth nerve which was treated once 
and disappeared for quite a long time. It finally returned and was quite a 
severe case, as hard a case to treat as a'ly that I had ever seen. We tried all 
sorts of treatment and finally got to treating it pretty nearly every day, and it 
did not do much better. Finally we told the gentleman not to come back to 
us inside of a week or two weeks, we had by this time quit taking his money, 
but were trying to do w^hat we could for him, so he was willing to do that. 
The result was improvement. We had simply stimulated until we had irritated 
and kept up the abnormality. 

Then, again, some lesions must be removed only gradually. If you go to 
work and remove the lesion instantly, you do not give nature time to accom- 
modate herself to the changed conditions. Nature has been for years at w^ork 
trying to adapt herself to the unnatural condition of things, and she has done 
so to a greater or less extent finally, ;.nd now you, as an Osteopath, tr^^ to 
change all that in a second's time. It can rarely be done. I have known of 
some cases where a very quick change of a lesion could be made, but it is not. 
a very common occurrence. I have he.ird Dr. Harry Still state that he had 
set a hip too soon and he had great difficulty with it until he had got it out 
again, because the muscles were all so contracted by being adap.ted to the ab- 
normal conditions. They would not relix as they would normally have done 
when the hip was in place, and he had great trouble to get it out again. The 
lesion should not be reduced too soon. In a case of asthma the "Old Doctor" 
says you should not treat oftener than once in ten days or two weeks, because 
by frequent treatment we keep up the irritation. 

I wish as soon as possible hereafter to take up certain centers and the 
consideration of the sympathetic system, that I left aside after the first few 



90 GENERAL CONSIDERATIONS. 

lectures, as it is an important subject. There are certain things which I wish 
to bring to your attention to-day in regard to them. Remember that stimu- 
lating accelerator fibers accelerates and stimulating inhibitory fibers inhibits. 
For instance, if you were to treat the heart and wish to stimulate its action, 
you will recollect that there are two sets of nerves innervating the heart; one 
the sympathetics, and the other from the pneumogastric. That the sympa- 
thetic keeps the heart running and tends to run it too fast, while the inhibi- 
tory influence of the pneumogastric is to bring about an equilibrium between 
the forces and keep it running just righ*. If it is not running just right, not 
fast enough, you will want to stimulate it a little, in which case you would 
stimulate the sympathetic suppl}^ to the heart through the upper dorsal and 
the cervical ganglia and you would inhibit the pneumogastric so as to remove 
the inhibitory influence. You would thus, according to the theory, get a 
stimulating effect upon the heart. If you wish to quiet the heart's action you 
would adopt just the opposite plan of treatment. That will illustrate the fact 
that stimulating a nerve stimulates it to its action, whether its action be that 
of an accelerator or an inhibitor. Stimulating vaso-dilators dilates. Stimu- 
lating vaso-constrictors constricts. This is very simple and perhaps it seems 
unnecessary to call it to your attention except in the connection it has with 
these other things. There are certain things to remember in relation to the 
vaso-motor system, and which though hard to explain are of a great deal of 
importance to the Osteopath. 

There are certain things concerning the centers and the fibers. It is said 
that vaso-motor fibers are present in some cranial nerves, for instance, the 
chorda tympani of the facial nerve. _The chorda tympani is the vaso dilator of 
the submaxillar}^ gland. The general vaso-motor center is in the medulla. It 
is said by Howell's Text Book, however, that that center is a constricting 
center, from which a continual constrictor impulse goes to all parts of the body, 
preserving the proper tonicity of the blood vessels, but he says it is not proven 
that there is any vaso-dilator center in the medulla. Simpl}^ not proven; there 
may be, however. The vaso-constrictor fibers, as before stated, leave the 
spinal cord from the second dorsal to the second lumbar, while vaso-dilators 
leave the cord all the way along, being not limited to certain places. 

We frequentl}^ meet with the terms, in description of the circulation, in- 
crease of blood pressure, and so on. Remember that stimulating vaso-con- 
strictors constrict the blood vessels, and thus lessens the quantity of blood in 
that part, but it increases the blood pressure. On the other hand, the vaso- 
dilators loosen the tissues and allow more blood to go to the part, but decrease 
the amount of blood pressure. I thought I would call that to your attention 
so you would not get those facts confused. 

A further fact that you must take into consideration is that sometimes a 
single anatomical nerve will contain more than one kind of fibers, vaso-dilator 
and vaso-constrictor fibers. That is true in the case of the sciatic nerve, and 
the result you would get in stimulating the sciatic nerve would be an average 



TREATMENT OF THK NKCK. 9I 

result between vaso-dilator power and vasoconstrictor power. Again, some- 
times stimulating a center will produce vaso-dilation and sometimes vaso-con- 
striction. You might have a vaso-dilator center and expect it always to pro- 
duce vaso-dilation, hut accordii g to Howell's Text Book the center is some- 
times changed in condition, and you get the opposite effect by its stimulation. 
Vaso-constrictors are less easily excited than vaso-dilators. Vaso- constrictors 
degenerate more rapidly when injured. The maximum effect of stimulation is 
more readily reached in vaso-constrictors than in vaso-dilators. Vaso-motor 
nerves are axis cylinders of sympathetic nerve cells. The pilo-niotor and sec- 
retory fibers we shall consider later when speaking of the structures in which 
they terminate. As we cannot be certain of all these things we have to de- 
pend more than ever upon the tendency toward the normal — we cannot always 
work to get a set vaso-motor or vaso-dilator effect. 

II. Treatment of the Neck. (Continued.) — The spinal accessory, 
pneumogastric and glosso-pharyngeal nerves emerge at the jugular foramen. 
We frequently have to treat them, especially the pneumogastric and the spinal 
accessory; the pneumogastric perhaps more often. We treat them in various 
ways. We can reach the pneumogastric by deep pressure over the exit from 
the skull — deep pressure just below the mastoid process will affect the nerve- 
Some work there. Others on the pneumogastric by stimulating all along the 
anterior border of the sterno-mastoid muscle. Thus you get a sort of a mas- 
sage and direct mechanical pressure upon that nerve and no doubt affect it 
there if our theories are correct. Another very good way to reach these three 
nerves is through the superior servical ganglion. That is, we work on the 
superior cervical ganglion to affect them. We may affect the superior ganglion 
by working on the sub and great occipital nerves. That is rather an indirect 
way, but it is claimed that we get an effect upon those nerves by working that 
in place. That is the method Dr. Hildreth used to reach those nerves. 

There are various ways in which we reach the phrenic nerve, one way is 
to carefully find its location opposite the transverse process of the third, fourth 
and fifth cervical vertebrae, and get slightly in front of them and impinge back 
upon them, thus pressing the nerve against the transverse process. That is 
one way. The way tha'. Dr. Harry Still treats the phrenic nerve is by thrust, 
ing the thumb between the clavicle and the first rib above; that is, thrusting it 
above the clavicle, between it and the first rib, then pushing the bent arm and 
hand on back over the shoulder in this way, thrusting the thumb in deeply at 
the sternal end of the clavical and holding in order to impinge upon the nerve 
and lessen its conductivity, thus inhibiting the action of that nerve. It is 
sometimes reached, as I showed you the other day by pressure at the sternal 
end of the clavicle. You can either press in the fouticulus gutturius, slightly 
backward, or between the sternal and clavicular ends of the origin of the steruo 
mastoid muscle, backward and inward, to impinge upon the nerve. The best 
place to treat it is the best place that your practice tells you 3'ou can reach it. 
Different ones treat in different places, and it also depends upon the patient, as 
to how thick or how thin his neck is. 



92 TREATMENT OF THE NECK. 

Next we will consider the trearment of the sterno mastoid muscle. We 
can get a direct sort of a massage by working right along its course. It is 
very readily worked upon in this way, relaxing it and drawing it toward you 
without rubbing the fingers over the neck. Another way is to follow the ob- 
liquity of the muscle and turn the head, thus stretching the muscle on the 
same side. Remember that, on account of the obliquity of the muscles behind, 
you will at the same time stretch them, and I find that a very good plan in 
giving the neck a general treatment, as I will show you later. Of course you 
may have some trouble with the spmal accessory nerves causing a stiffening of 
the sterno-mastoid, in which case you must give il attention. 

Now as to treating the neck proper, or the back of the neck. The first 
thing is to loosen up all of the muscles. In giving this treatment I always 
use the flat of my hands, lay them directly on the neck, and have thus a broad 
hold and do not run an}' risk of hurting by pressure with the tips of the fins 
gers. I usually go to work in this way and work straight backward, thus 
loosing all of the muscles, giving a certain twist or turn as I work. You will 
be able to recognize by the sense of touch when you have relaxed everything. 
It is also good to relax the muscles by working from the side. - Remember, 
above the third cervical to work upward and below it downward. I simply 
relax all the muscles that are rigid. Then when you have them thoroughly 
relaxed, it is a good idea to still further relax the deeper structures by a 
straight pull. I hold beneath the jaw^ and occipital protuberance and draw 
the patient toward me, that stretches the neck. I have warned you not to 
turn it while stretching it in that way. 7 then turn the neck strongly from 
side to side in <^^his general treatment of the neck, loosening all the deeper 
structures, stimulating all the parts about the vertebrae and loosening the 
ligaments. Then before finishing the neck I usually stretch the li^amentum 
nuchae and also the other ligaments about the vertebrae, as I have already 
shown you how to do. 

It is an important question how to treat the cervical ganglia of the sympa- 
thetic. As I said, we usualh' affect them by treatmg the sub- and great occip- 
ital nerves, that is. b}^ pressure in the sub-occipital fossae. The way in which 
we inhibit their action is by holding deeply in those fossae and then turning 
the head from side to side, rotating it as you go, and you thus work deep into 
"the parts trying to get direct pressure upon the sub- and great occipital nerve- 
Through their connection with the cervical sympathetic you influence it. Some 
operators treat that way almost entirely and results would indicate that they 
were accomplishing what the}^ were attempting. You must not be in a hurry, 
but turn the head slowly from side to side and hold firmly. Some treat the first 
ganglion directly by pressure opposite the second and third cervical vertebrae, a 
little in front and backward, thus impinging it against the hard parts of the 
spines beneath. In the same v/ay you can reach the second one, the third I 
think you cannot reach from the front of the neck, that must be reached indi- 
rectly through sympathetic connections with the spinal nerves behind. 



TRKATMKNT OF THE NKCK. 9;^ 

To Stimulate these ganglia, pressure and relaxation are employed. 

In treating an atlas we use a combination of motions already shown, that 
is, a thorough loosening up of all the parts. Then by traction, rotation and 
pressure upon the prominent part you can work it back into its place. Of 
course it takes time, and frequently has to be done very slowly. That same 
method can be pursued for all the cervical vertebrae. It is something you will 
have to learn by experience. Another way to set the atlas is with the patient 
sitting on the chair. This is a move that Dr. Still showed us not a great 
while ago. He gets his knee under the jaw and rotates the head in a direction 
to throw out very prominantly, the part which is out of place, and then getting 
his thumb or fingers upon thatpartandsi mply rotates the head back again, 
the idea being extension and flexion in such a way as to disengage the articu- 
lar processes and allow the part to resume its normal position. 

In order to work out the sore places that you will frequently find in the 
sub-occipital fossae and just beneath the occipital protuberance you should re- 
lax all the parts, both the ligaments and the muscles. 

I will now show you how I usually work upon the neck; I will work just 
as if I had come in and found this neck in a generally bad condition and wish 
to relieve it. The treatment of the neck is a very important thing. You need 
not be afraid of getting down close to the shoulder and stretching all of those 
muscles. It is a good thing to get the head against you and push downward 
as you turn, you can thus sometimes relax the parts and start the vertebrae 
toward their normal position. It takes considerable time to treat a neck 
thoroughly and well. One thing which I did not mention is that you can 
stretch the scaleni muscles very readily by holding the head straight and turn- 
ing it, pushing it directly to the side. If it is a case of headache I save the 
inhibiting movement until the last, and by holding firmly in the superior cervi- 
cal region, particularly at the sub-occipital fo.ss8e, I get good results as a rule 
on the head in that way. 

Q. You were speaking of stretching the pyriformis muscle. Please show 
us how that was done. 

A. That muscle is an external rotator, and an extreme internal rotation 
will be all that is necessary to stretch it. Work opposite to the defect. 



LECTURE XVI. 

At the last lecture I invited your attention first to the general principle of 
our treatment, that manipulation always tends to restore parts to normal, fol- 
lowing it out along the idea that therefore should we manipulate a part which 
was not diseased, we need not be in any fear that we would make in abnormal, 
because the tendency would be to excite it in the way that normal exercise 
would excite it. But we by manipulation of the abnormal, on account of this 
tendency, result in tending to the normal and in helping to cure the diseai^e. 
That is a partial explanation of why our friends, the "engine wipers," who 



94 THE PHRENIC NERVE. 

work over nearly ail the body and work for nearly an hour, can get some re- 
sults, when they are not Osteopaths at all. Another point was that you 
should take the pain as the cue, and to work the part or stretch it in the direc- 
tion in which you get the resistance, since thereby you work against the lesion. 
I explained about how general that should be, that you should not irritate in 
so doing. Although the question of stimulation and inhibition is a secondary 
one to removal or lesion, that we sometimes stimulate or inhibit irrespective of 
lesion or after removal of it. In general, we inhibit by pressure, by holding: 
and stimulate by brisk work similar to making and breaking of an electric cur- 
rent, and that there was a question of degree of force; that you might stimu- 
late hard enough to inhibit. There were certain elementary points concerning 
nerves which I thought would be profitable to bring to your attention: That 
stimulating an accelerator nerve accelerates, stimulating a vaso dilator dilates, 
stimulating a vaso-constrictor constricts. I also called certain centers to your 
mind, the fact that the center in the medulla is a vaso-constrictor center, and 
that a vaso- dilator center has not been found to exist, although it may be there. 
I. The Phrenic Nerve. What I wish to-day to do is to notice, more par- 
ticularly something concerning the phrenic nerve. You all know its location 
and treatment; how it arises from the 3d, 4th and 5th cervical nerves, espec- 
ially the fourth, having some branches from the third and a recurrent branch 
from the 5th; that it is reached in different ways; being impinged against the 
transverse processes of the vertebrae, or being reached at the fonticulus gut- 
turus, or Eetween the first rib and the clavicle; that it is important to us, but 
has been so mainly as a means of stopping hiccoughs. However, I think it 
should be of greater importance to the Osteopath, and while I have not heard 
these matters brought out that I am going to bring out this afternoon, yet I 
mention them in the way of suggestion for further work. Perhaps I do not 
know all that others have done with the phrenic nerve; these points are more 
in the manner of theories, but if what I have already said is true, certainly the 
phrenic nerve has considerable importance to us as an adjuvant to our work. 
The phrenic nerve has important connections with the sympathetic system. 
Gray says that the phrenic nerve supplies the pericardium and the pleura by 
filaments; that in the thoracic cavity a filament is seen from the sympathetic 
joining the phrenic nerve, and that there are also branches to the peritoneum. 
From the right nerve there are branches to the phrenic ganglion, which is situ- 
ated just below the diaphragm, the terminals of course, perforating the dia- 
phragm to reach this phrenic or diaphragmatic ganglion of the sympathetic. 
This ganglion of the sympathetic is, of course, connected with the solar plexus. 
This ganglion sends branches to the hepatic plexus, and also sends some fila- 
ments to the inferior vena-cava. Of course its function as a spinal nerve is to 
supply the muscle of the diaphragm. From the left nerve branches go to join 
the solar plexus, but there is no ganglia formed. Quain substantiates those 
points, and says further that branches reach the phrenic in the neck from the 
middle or the lower sympathetic ganglia, some branches going to the pericard- 



THE PHRENIC NERVE AND ITS SYMPATHETIC CONNECTIONS. 95 

ium. And that from the right nerve were branches going to the inferior vena 
cava, both above and below the diaphragm, and that branches also go to the 
right auricle of the heart. Pansina, according to Quain, has found in animals 
that the phrenic plexus of the diaphragm is participated in by the lower three 
intercostal nerves. You will see that the purpose is to associate the muscles of 
respiration, the abdominals, intercostals and the diaphragm itself. Quain states 
further, that the phrenic may have a branch from the hypoglossal nerve and 
and from the 5th cervical nerve. Such are the facts in relation to the phrenic 
and its distribution. When we examine those facts in the light of Osteopathy, 
it seems certain that we find the phrenic significant to us in more ways than 
one. You see from what I have said that the phrenic is connected with the 
sympathetics; first with the middle or lower sympathetics in the neck; next 
that it receives a filament from the sympathetic in the chest; next, that it per- 
forates the diaphragm to join the nerves of visceral life, those on the right run- 
ning from the diaphragmatic ganglion, those on the left joining without the 
intervention of a ganglion. You notice further that it has a connection with a 
cranial nerve — the hypoglossal; that it has branches connected with the brachial 
plexus, that is, from the 5th cervical; and that it may perhaps join with the 
lower three intercostals, but T do not know that that has ever been shown to 
be true in man. The conclusion is obvious, then, from what we know of the 
connection of nerves in different parts of the body, both sympathetic and other- 
wise, that if any of these sympathetic, spinal or cerebral nerves were diseased, 
the disease might conceivably be extended to the phrenic and affect it, and 
that we might have phrenic symptoms arising from these other troubles. The 
reverse of course is true, and that any of these structures which are supplied 
by the sympathetics or these other nerves, may reflexly be affected by the 
phrenic nerve when diseased. You have seen that it supplies the pericardium, 
pleura and peritoneum, that it supplies one of the great blood vessels, the in- 
ferior vena cava, and sends branches to the right auricle of the heart, and there 
is no reason, according to our theory, why disease in any of these situations 
might not affect the phrenic nerve, and you might have symptoms of disease in 
the phrenic nerve. So that our theoretical rule is certainly a good one, for it 
wnll work both ways, either affecting the phrenic nerve or the other structures 
as the case may be. The importance of this to us liesm the fact that it would 
bean adjuvant in the treatment already used. It is one more path by which 
we can influence nerve force. We have certain ways of reaching the abdominal 
viscera through the splanchnics in the baci?:; we might have a case where we 
couM not get at it in that region, but if we could reach the trouble through the 
phrenic, we would accomplish the desired result. As I have said, these facts 
are not fully demonstrated, but it is a theory which I leave for your consider- 
ation, and which you can work on in your practice. It comes to us another 
key to unlock the doors of sympathetic life; another wa^' in which we can work: 
another tool in our hands. 
. I wish to call up what Dr. Hilton says in regard to the phrenic nerve; he sets 



96 THE PHRKNIC NKRVK. WORK UPON NERVE TERMINALS. 

out ver}^ clearly why it is that it perforates the diaphragm and is distributed 
on its lower surface rather than upon its upper surface. He shows that were 
it distributed to the upper surface the nerves would then be impinged upon by 
the lungs, and you would have constant interference with nerve force, but it is 
distributed on the under side of the diaphragm where it is removed from the 
tendency of pressure of parts above, and the tendency of the force of gravita- 
tion is to draw away the stomach, liver and spleen from the under surface of 
the diaphragm, so that there can be no interference with the plexus situated 
below the diaphragm. Dana makes use of this tendency of gravitation in the 
<:ase of hiccoughs, but in a somewhat different way. That is, he states that it 
has a very effective action in hiccoughs. He places the patient on a table with 
his head down over the edge of the table, that would allow the thorax to arch 
up, and the action of gravitation would allow the heavy viscera to impinge up- 
on the under surface of the diaphragm, and it would in that wa}^ be helpful in 
stopping hiccoughs, by inhibiting the nerves of the plexus. Hilton does not 
explain it so. It may be that the stretching of the thorax, thus extending the 
contracted muscle would by its extension send an impulse back over the nerve 
and quiet the spasm. I have not heard it explained why the drinking of cold 
water stops hiccoughs, but there may be an explanation here in connection 
wi'ch the sympathetics; that the action of the cold water may be such as to for 
a while inhibit the action of the sympathetics, sending an action refiexly back 
to the phrenic from its sympathetic connections, and thus causing the spasm of 
the hiccoughs to be released. So that in our work upon the abdominal viscera 
we may avail ourselves of the advantage of work in the neck on the phrenic. 
Dana states that he treats diaphragmatic palsy by electricity applied to the 
neck He says there is a motor area in the neck which is readily affected by 
the electric current. So that it no doubt corresponds with the work we do 
when we bring pressure directly upon the phrenic nerve. 

I wish to quote from Dr. Jacobson along this line as follows: "Another 
reason for the phrenic nerves traversing the diaphragm, and breaking up into 
branches on its under surface may be to enable them to come into communica- 
tion with the sympathetic or visceral nerves of the abdomen. From this com- 
munication branches are given to the hepatic and solar plexuses, and the infer- 
ior vena cava. Everyone knows the value of active exercise when certain ab- 
■dominal viscera are torpid in the performance of their functions, e. g., in con- 
stipation, biliousness, etc. The perforation of the diaphragm by the phrenic 
and its communication with the abdominal sympathetics must bring the brain 
and spmal cord, the diaphragm and abdominal muscles, so important in active 
respiration, into intimate association with the subjacent viscera." So says Dr. 
Jacobson. Hence, we see that we can go farther, and saj-, that since the brain 
and cord are thus brought into connection through the phrenic with the sym- 
pathetics and with abdominal sympathetic life, and since it must send certain 
impulses along those nerves and thus affect abdominal sympathetic nerve life, 
there is no reason why the reverse may not be true. And why ma}^ we not af- 



THK PHRENIC NERVE. WORK UPON NERVE TERMINALS. 97 

feet the brain and cord by working back from the sympathetics, and more par- 
ticularly when there is a lesion, because manipulation must tend toward the 
normal? You would manipulate the phrenics; the abnormalities would be af- 
fected, you would affect the phrenic, and thus be more likely to affect other 
nerves which have under control that which has become abnormal. There is 
no reason, according to our theory, why we would not tone up the whole mech- 
anism of respiration, especially the muscular respiration, since it is in connec- 
tion with the phrenic nerve and with the abdominal. 

I emphasize once more what I have said frequently before — that work 
upon nerve terminals will affect the nerve itself and will affect the center from 
which it comes. I think that position taken by Osteopaths is impregnable. I 
wish to quote from Dr. Hilton in a case of pain in the knee, where the trouble 
was in the hip, which the Osteopath often meets, and which shows us that 
doctors are not always in the dark in their diagnosis of these cases. Dr. Hilton 
says: "Again, we find some patients with hip joint disease suffering from 
pain in the knee. Now, although the disease does not lie there, we know that 
the pain can be relieved by a belladonna plaster, or strong hemlock poultices, 
or fomentations applied over the knee joint; thus acting upon the nerves of 
the hip joint through the medium of those which are spread over the knee- 
joint." He has made the point previously that the nerves of a joint supply 
also the skin over the joint and over the insertion of the muscles which move 
the joint. So you have one nerve going to a joint, to its muscles and to the 
skin over those muscles. We see that the therepeutic value of work upon 
nerve terminals has been recognized and used long before this. Our method is 
peculiar in this: that it works upon nerve terminals exclusively by manipu- 
lation and its effects. Perhaps some of you have heard of certain exercises 
for troubles of the stomach, bowels? liver, etc. It is recommended that 
the patient who has torpid liver should every morning get down on all fours, 
that is, keeping the legs straight and walking on the hands and feet, and run 
briskly around the room, that if he would do that it would press the liver 
and squeeze it like a sponge and could not help but stir up the torpid circula- 
tion from the portal system. There is another stooping motion given in which 
the patient keeps the back straight, bends his knees and allows his body to 
sink down straight, then he can bend so that the shoulders touch the 
knees: You will notice that it is a sort of pumping motion, it will stretch the 
spine atd knead the bowels and abdomen thoroughly. Often this may be of 
practical use, and you might suggest it to patients with similar troubles. Now 
what would be the effect in such a case? I do not think it would be simply 
local in pumping the blood through the abdomen and its contents. I think 
that the tendency there would be to aft'ect the nerve suppl3\ if our work and 
our theory go for anything, and aft'ect generally the abdominal nerves, and 
through them the centers, which may themselves be in an abnormal condition. 
The tendency continually toward the normal would tell us why work upon the 
abdomen should affect cerebral centers and thus restore them to the normal. 



98 LANDMARKS OF THK HEAD. 

We had quite a marked case in Chicago some time since. A lady patient told 
Dr. Sullivan that she had been treated by an Arabian doctor, who adopted a 
queer method. She said he had directed her to fix her mind upon the point in 
view every day at a definite time, and he had given her particular instructions 
as to how it should be done, and she said she was perfectlj- restored from con- 
stipation. The explanation given was that by thus working on the mind this 
doctor had finally led his patient to gain control of the cerebral center which 
has to do with these functions. 

I have already examined the neck before you, and shown you how to treat 
it. I think we are ready to take up the head. I may say in passing that it is 
my idea to first go over the bod 3^ piece by piece, give you the examination and 
treatment for different pieces of the body. That is a piecemeal way to do, but 
it will give you an analysis of the whole. After I have done that, we vShall 
have synthesis, and I will take up special diseases and show you how to exam- 
ine and treat the case, combining different movements and treatments accord- 
ing to circumstances. , 

II. Landmarks of the Head. Holden notes the following: That the 
scalp is very tough and dense on account of its close connection with the apo- 
neurosis. That its density, therefore, often obscures the growth of tumors upon 
the cranium. A tumor beneath the aponeurosis may very readily be confused 
with a growth from the scalp itself or from the the brain, and in general such 
tumors are firm and resisting. Other tumors that are above are very readily 
movable, and when thev are movable I believe the point is general that they 
are not so serious. The supra-orbital artery is felt pulsing just above the 
notch. You all know where the supra-orbital artery is, at the junction of the 
inner and middle thirds of the supra-orbital arch. It runs thence up oyer the 
forehead, and by carefully feeling you will be able to note the pulse. 

The temporal artery is felt an inch and a quarter behind the external angu- 
lar process of the frontal bone. The occipital artery is felt near the middle of 
a line drawn from the occipital protuberance to the mastoid process. The pos- 
terior auricular artery is felt pulsing near the apex of the mastoid process. I 
think it is a very good way to train the touch to feel for the different arteries 
at different places. 

It is said that the skull cap is rarely exactly symmetrical. The promi- 
nence of the frontal, parietal and occipital portions of the cranium is a partial 
indication of those respective parts of the brain, and it is stated a good way to 
measure their relative proportions is to pass a string from one external auditory 
meatus to the other, first over the frontal, then over the parietal, and then ov- 
er the occipital eminences, and thus you can get an idea of the comparative 
bulk of these lobes of the brain, because it is said the lobes of the brain cor- 
respond in general to these parts. 

The anterior fontelle in the infant, you are familiar with. It should be 
carefully noted whether the condition is a hill or a hollow. Of course normally 
it is even. If it is a hill it will indicate too much cerebral fluid present, as in 



KXAMINATION OF THK HEAD AND FACE. 99- 

hydrocephalus. But if there is a wasting of the fluids of the body, as in diarr- 
hea, you may have a hollow there. Normally, the rate of the pulse beat may 
be counted at the fontelle of a sleeping infant. The frontal sinuses do not gain 
their normal size until after puberty. The absence of them is not indicative of 
much because they grow inside, or if they are very prominent it may be simply 
a heaping up of the bone and a degeneration. 

The mastoid process is filled with air cells, lined with mucus membrane, 
and it may develop as other mucous membranes do, a catarrhl condition and 
lead to suppuration. The occipital protuberance is the tickest part of the skull^ 
about three-quarters of an inch thick. The part at the temple^is the thinnest, 
and may be as thin as parchment, it is stated. The external auditory canal 
runs slightly forward and inward, hence in examining^you must pull the auri- 
cle backward and upward. 

Marks for the face:— The three points of the three terminations of the fifth 
nerve are at the supra-orbital, infra-orbital and mental foramina, respectively. 
A line passed down from the supra-orbital foramen, passing betweec the two 
bicuspids, will pass over these three foramina. Of course nerve terminals are 
important with us, and we get an important effect on the fifth nerve by work- 
ing on these terminals. The two lower foramina look toward the nose. 

III. Examination of The Head and Face. — Of course I do not need 
to state to you that the examination of the head and its parts, embodying as it 
does, the eye, ear, nose and throat, upon any one or two of which some spend a 
lifetime of study and work, lecture and treatment, can be encompassed by a few 
lectures. We all recognize the importance of the subject. However, I think 
we can take a general view of this subject now in a few lectures and depend on 
later lectures and later experiences to enlarge upon our knowledge. The Os- 
teopath has good success with troubles of the head, brain troubles, diseases of 
the eye, ear, nose, and throat, and diseases of the face. His treatment is very 
simple, being for the greater part in the neck. Troubles of the eye and ear 
are, as you know, closely associated wath the superior cervical ganglion of the 
sympathetic and with the various vertebrae. Dislocations of these vertebrae are 
very important. The atlas will affect the ear, and the atlas and upper cervical 
will affect the eye. So that in any examination that you make of the head and 
its parts you must do it in connection with the neck. Please remember that 
the separation of these subjects has been merely for convenience, but that all 
work together. For instance, you may find a catarrhal condition of the head 
where the cause may be entirely in the neck. You ma^- have a case of insanity 
where the trouble is wholly in the neck. With these remarks I think you will 
note the importance of examining the neck, and of treating it in connection 
with head troubles. 

In examining a patient at any time you should note the size and shape of 
the head; you should look for the presence of tumors or ulcerations upon the 
scalp or beneath it, and also carefully examine to see if the head is bald. Al- 
ways notice the face as it is a great indicator of disease; notice the countenance ; 



lOO EXAMINATION OF THE HEAD AND FACE. 

the expression. You will frequentl}^ come across in medical literature the fact 
that the patient has a worried expression. Your patient will sometimes wear 
an anxious expression. Different diseases affect the countenance differently, 
and 3^ou will often meet this anxious expression of countenance, so that is an 
mportant indicati o n, as is also the complexion. You have all seen the eom- 
dlexion of jaundice; stomach trouble will have its effect upon the complexion; 
certain diseases of the genitals will cause eruptions on the face. These things 
you will bear in mind. In looking at the face always note the lower jaw. It 
is especially important from the Osteopathic point of view. It may be slipped 
backward or forward or it may be deviated from one side, and in being so may 
cause a tightening of the ligaments of the jaw causing serious results. It may 
affect the ear, or it may have something to do with neuralgia of the fifth nerve. 
In looking at the eye, always notice the conjunctiva, whether or not it is 
engorged with blood, whether or .not it is yellow, whether there is any 
growth upon it, or any abnormality whatever concerning it. Note whether or 
not the eye is brilliant; in some it is dull. All of these points should be signi- 
ficant to you. There may be growths upon the eye, e.g.. pterygium, which have 
been successfully treated b}' Osteopaths. You may find cataract; we have had 
some success in curing this also b}' Osteopath}^ It is well in examining a pa- 
tient to note whether or not the iris reflex can be obtained. Dr. Harry Still 
always says there is considerable hope for an eye if you can find on examina- 
tion that the iris will readily dilate. He just taps the closed eye, putting one 
finger upon it, tapping three or four times gently with another; if that has 
caused the iris to dilate you will know that the reflex is intact. You can also 
determine this by shutting off the light and then instantly turning it on, the 
reflex being manifest in the same way. You should in your examination of 
the eye note what is the color of the mucous membrane. A very pale color 
will indicate an absence of sufficient nutriment; absence of blood supply. In 
anemia the the mucous membranes of the whole body are pale, hence you will 
want to examine the eye in health to acquaint yourself with these phenomena. 
In examining the eye we have to turn back the lids, the under lid is very read- 
ily turned back and down, and you can examine it and notice if there is any 
foreign body upon it. The upper lid is not quite so readily turned back. You 
can do it with a pencil, or you can push it right up and back. Note the meibo- 
mian glands and note whether or not there are any granulations or any foreign 
growths. It will be well for you to note whether or not the tonicity of the 
muscles about the eye is normal, holding the puncta lachrymala against the 
globe of the eye. A growth may obstruct the duct producing the same result, 
and you want to know whether or not it it is simply a loosening of the muscles 
or some obstruction in the duct. You may in looking at the eye discover a 
foreign body. Sometimes 3'ou can see it, sometimes you have to look oblique- 
ly across the cornea of the eye. It may be stuck on the cornea and you will 
have to look at it by an oblique light, so as to see whether the surfaces are 
clear. Looking at it obliqueh' will also enable you tosee f)terygiums, although 



OSTKOPATHIC POINTS CONCERNING THE EYE. lOI 

these are general!}' readily seen by looking at it directly. The presence of 
dead lashes is sufficient cause of disease; you can have quite a sore eye merely 
on account of dead lashes being left in the lids. They should, I think, be reg- 
larl}' pulled out every once in a while, and should be gently tried to see wheth- 
er or not they will come out. It is said that if a person will keep them remov- 
ed he will not have trouble with his eyes. When they have become lifeless you 
will see little black points on the eye-lids. It is said a fullness under the eye is 
indicative of dropsy, The presence or absence of a ring about the eye is also 
indicative of the general health. 

LECTURE XVII. 

I spoke last time of the phrenic nerve, showing how it has connection with 
the sympathetic, and advancing the theory that very possibly impartant results 
might be obtained Osteopathically by working upon this nerve for the sake of 
influencing its connections, calling to your attention the fact that it supplied 
the peritoneum and pericadium, send branches to the inferior vena and a branch 
to the right auricle of the heart. That is also connected with the sympathetics 
below the diaphragm and thus had very important connections with visceral 
life. That it also connected with a cranial nerve, the hypoglossal, and with 
spinal nerves, viz., the 5th cervical, and that in some animals connection had 
been noted between the phrenic and three lower intercostal nerves. This con- 
nection v/ith the muscles of respiration is to cause them to work in conjunction. 
That is the theory supported by the quotation from Dr. Jacobson — that work 
upon, or exercises that would influence the abdominal viscera would thus have 
an influence upon the brain. It seems likely that b}^ work upon these parts we 
can get an influence over the parts affected and thus perhaps reach brain cen- 
ters and gain an influence over them. I noted also the value of such exercises 
as stooping, those which would bring a squeezing motion upon the liver, intes- 
tines and stomach, and .showed how it might through these nervous connections 
affect the parts which were at fault. I then explained certain points concern- 
ing landmarks about the head and face, and spoke upon the subject of how to 
examine the head, face and its parts. I wish to-day to continue that line of 
thought, giving particular attention to the eye. 

I. Osteopathic Points Concerning the Eye: — We are aware that the 
nerve supply of the eye, which is itself a nervous oro^an, is various and impor- 
tant, and we shall see later in the lecture that we have quite a broad held upon 
which to work to reach the eye. I have already given you some centers for 
the eye and have alread}^ spoken, in considering the neck, about the blood sup- 
pi}^ to the head and its parts, and it is also of course ver}- important to us. We 
get our effect upon it through the nerves; the superior cervical ganglion is the 
chief center upon which we work to affect the eye. I have seen a case of 
"blood shot" eye, as we call it, cured by treating in the superior cervical re- 
gion; simply by inhibiting the action of the sympathetics at that place. So you 
S2e the sup2rior cervical ganglion has an important control over the nieclip.ni-in 



I02 THE THIRD NERVE IN REI.AT10N TO THE EYE. 

of the blood supply. We probably affect it through the ascending branch to 
the carotid and cavernous plexuses, and no doubt also through the connection 
which it has with the fifth nerve — the fifth nerve having important vaso-motor 
fibres to the eye. Quain, in his anatomy describes branches from the cavernous 
plexus which run to the cerebral and ophthalmic arteries, forming a secondary 
plexus about them, and from them, he says, some branches go to the eye ball 
and form a plexus of the sympathetic in the eye-ball itself. Hence, you see, 
we have a very important and direct connection with the sympathetic through 
the superior cervical ganglion, through its ascending branches, and this termi- 
nal sympathetic plexus in the eye-ball. The ciliary ganglion is also impor- 
tant in relation to our work upon the eye. It has connection with the third 
and fifth cranial nerves and the S3'mpathetics. The third and fifth nerves are 
important, as you will see later when I shall take that up more in detail. Con- 
cerning the ciliary ganglion, Quain says: "The ciliary, ophthalmic or lenticu- 
lar ganglion serves as a center for the supply of nerves, motor, sensor37 and 
sympathetic, to the eve ball." Thus we have a center on which we may work. 
Further, he says, "The sympathetic root is a very small nerve which emanates 
from the cavernous plexus." So the ciliary ganglion gets its sympathetic sup- 
ply for the eye from the cavernous plexus. The ciliary ganglion lies at the 
bottom of the orbit between the rectus muscle and the optic nerve. 

There is a treatment which we frequently give the eye, not 
tapping, but a pressure of the eye back into its socket; and I 
think the effect there must be on the ciliary ganglion, and since it 
is connected with the third and fifth nerves, we could undoubted- 
ly, if there were abnormalities, get an effect upon those nerves. Thus, work- 
ing in this way we might affect the third nerve and tone up the muscular me- 
chanism of the eye, or working in this direction on the fifth nerve, we might 
tone up the nutrition of the eye. Thus you see by pressure we have reached 
not a nerve, but a center, and the reverse is clearly true according to our theo- 
ry, that we might work upon terminals, as for instance terminals of the fifth 
nerve which are readily reached in the face, and in that way get an effect upon 
this ciliary ganglion which is connected with the fifth nerve. Or, by working 
as we do, through the superior cervical ganglion to reach the third nerve, we 
might have an effect upon the ciliary ganglion, of course through its sympa- 
thetic connection. This will serve to show you how closely connected is all 
this nerve supply to the eye. One is quite dependent upon the other, and in 
affecting one you affect the other, provided it is in need of treatment. Thus 
you see that by working on this theory you can affect not only sympathetic 
life, but sensation and motion of the e3'e, since these nerves send branches to 
the eye. A little further with regard to the third nerve and its connection 
with the eye ball: It innervates all the muscles of the eye ball, as you know, 
except the external rectus and superior oblique. Through the ciliary ganglion 
it also rules the sphincter of the iris. Howell's Text Book states that there 
are fibres antagonistic to this motor occuli from the ciliary ganglion, which 



THE FIFTH NERVK IN REIvATlON TO THE EYE. I03 

constrict the iris and lesson the aperature of the pupil. The antagonistic fibres 
to this motor occiili come from the third ventricle, through the bulb, the cervi- 
cal cord, the anterior roots of the upper dorsal nerves, the upper thoracic gang- 
lion and the cervical sympathetic cord, and thus that it joins the ophthalmic di- 
vision of th2 fifth nerve passing through its nasal branch and its long ciliary 
branches to the iris. These anlaganistic fibres, of course, must be dilators. 
Thus from the more occuli you get the motor fibres to the spinchter of the iris 
and from the region I have just explained you get the dilator fibres of the iris. 
Hence, we dilate the iris by stimulating the superior cervical ganglion or stim- 
ulating in the upper dorsal region, more particularly the latter. Quain, in 
speaking of fibres from the cervical ganglion, notes these centers: pupilladilat or 
fibres arising from the ist, 2nd and 3rd dorsal nerves, then passing upward in 
the ascending branch of the superior cervical ganglion, reach the Gasserian 
ganglion, and the eye through the first division of the fifth nerve and the long 
ciliary nerves. He also sa>'s in parenthesis that it is stated by many observers 
that the pupilla dilator fibers are contained also in the 7th and 8th cervical 
Tierves. Motor fibres run to the involuntary muscles and orbit and the 
eye lids from the higher four or five dorsal nerves. Thus you see along 
the cervical region, from the sup rior cervical ganglion down as low as 
the 6th dorsal you may get an important effect upon the eye. 

Concerning the fifth nerve and its connection with the eye ball, I have al- 
ready noted its connection with the ciliary mechanism; that there are dilator 
branches from the cervical and upper dorsal through the nasal branch of the 
fifth, and that it has counnection with the Gasserian ganglion. The ophthalmic 
or first division of the fifth nerve, which is sensory in function, joins with 
branches from the sympathetic derived from the cavernous plexus. This nerve 
supplies the lachrymal glands, the conjunctiva of the lids and of the e^^e ball, 
and the skin about the lid and face of that part. The fifth nerve is also very 
important in the nutrition of the eye, the face, and different parts of the head. 
Green's Pathology notes the fact that upon section of the fifth nerve keratitis 
or inflammation of the cornea arises, followed by ulceration. Kirke makes the 
same statement, and says further that the disease may progress so far as to 
destroy the whole eye-ball. Kirke also states that in the case of fifth nerve, 
the fact that there are trophic fibres in it is proven by experiments of ^leissuer 
and Buttner, who found that division of the innermost fibres is most potent in 
producing decay. Howell's Text Book states that vaso-dilator fibres for the 
face and mouth are found in the cervical sympathetics; that they leave the 
cord at the second to the fifth dorsal; that they connect with the fifth nerve by 
passing from the superior cervical ganglion to the Ga.sserian ganglion. That 
^other dilator fibres for the .skin and mucous membrane of the mouth and face 
>seem to arise in the fifth nerve itself, also some in the nerve of Wrisberg. He 
states further that excitation of the cervical sympathetic causes constriction; 
■excitation of the thoracic sympathetic, dilation of the retinal arteries. Thus 
you see that working from the cervical sympachetic, getting an influence along 



I04 THEORY OF OSTEOPATHIC WORK UPON THE EYE. 

the path of the fifth nerve, you have a vaso-motor effect upon the retina. So 
you have not only trophic but vaso-motor fibres in the fifth nerve, supplying 
the eye. Quain states further that the retinal fibres leaving the sympathetic 
at the superior cervical ganglion pass to the ganglion of Gasser and to the eye 
from the ophthalm ic branch of the fifth nerve through the gray root of the 
ophthalmic ganglion and the ciliary nerves. Almost all of the fibres of the an- 
terior part of the eye are found in the fifth nerve, hence, you can readily see 
the great importance that the fifth nerve bears to Osteopathic work upon the 
eye, because there is hardlv au}^ trouble in the eye which may not be influenc- 
ed through the nutrition, and such troubles are readily within the reach of the 
Osteopath. 

Taking into consideration the facts, then, we note first, that the eye is 
readily reached by the Osteopath in two ways; through its blood supply, and 
through its nerve supply. We note further that the chief points at which the 
Osteopath works to affect the eye are the third nerve, the fifth nerve, the su- 
perior cervical ganglion, the upper dorsal region, and also the ciliary ganglion; 
that, as I noted in the beginning, the superior cervical ganglion is the most 
important point upon which we w^ork in treating the eye, since, as you have 
seen, it is connected with the third and fifth nerves, and also with the ciliary 
ganglion. Also that through it you get an effect upon the iris, upon muscles, 
and upon nutrition and sensation in general. So that the Osteopath certainly 
is not lacking for means of reaching the eye. 

We note further that there is a constrictor center for the iris in the ciliary 
ganglion and in the superior cervical ganglion; that there is also a dilator cen- 
ter in the upper dorsal region and in the superior cervical ganglion. That is, 
dilator center for the iris. That is something that might be a little confusing, 
that in the superior cervical ganglion you may have both a constrictor and dila- 
tor center for the iris. However, Dr. McConnell states that we may contract 
the iris by working at the upper cervical region, and that we dilate it by work- 
ing down at the second and third dorsal. That has been our experience, and 
although there seems to be a confusion of centers there we go according to re- 
sults. We may work in one way upon the fifth nerve by treating the super- 
ior cervical ganglion, and we get an important effect upon the fifth nerve by 
working up its terminal branches. As I pointed out to you at the last lecture, 
the terminal branches of the fifth nerve are readily pressed upon at the supra- 
orbital and infraorbital foramina, as well as at the mental foramen, and since 
we have shown that working upon terminal fibres is an important part «:f our 
work, and that through them we can gain important effects upon connected 
nervous mechanism, I think it shows that we have a good opportunity to 
reach and effect the nervous mechanisms of the eye through the fifth nerve. 

I also noted at the last lecture, the importance of examining the neck in 
any trouble of the eye or part of the head. If there is any dislocation of the 
atlas or of the third cervical, these points are particularly significant in regard 
to eye troubles, or there may be an interference at the inferior maxillary artic- 



LANDMARKS OF THK FACE. EXAMINATION OF THE EYE. IO5 

ulation — a slip of that articulation, impinging from fibres of the inferior maxil- 
lary division of the fifth nerve, and since in that way you may affect the whole 
nerve, it may have an effect upon the eye. 

Byron Robinson quotes from Fox that, "Irritation of the peripheral end of 
the cervical sympathetic will cause a protrusion of the eye ball, while section 
will cause a sinking of the eye ball." . Dr. McConnell spates that there are 
fibres which aid in the control of the metabolism of the retina at the fourth 
and fifth dorsal, and the strong stimulation of the nerves of the sexual organs 
causes dilation of the pupils and protrusion of the eye ball. 

II. Further Landmarks in Regard to the Parts of the Head and 
Face. — According to Holden we notice the following points: You will readi- 
ly feel the pully of the superior oblique muscle by pressing the thumb just un- 
der the inner edge of the orbit. The seventh nerve has its exit from the cra- 
nium at the stylo-mastoid foramen. It then passes forward and runs into the 
parotid glands. It sends branches upward to the temple, toward the eye, the 
cheek and jaw. The parotid duct lies on a line drawn from the bottom of the 
lobe of the ear to midway between the nose and the mouth, and empties oppo- 
site the upper second molar tooth. It is accompanied by a branch of the facial 
nerve supplying the buccinator muscle. The pulsation of the temporal artery 
may be felt between the root of the zygoma and the anterior part of the ear. 
And it is said that that is a very convenient place to feel the pulse of a sleeping- 
patient. The facial artery is very important in our work. It passes over the 
inferior maxillary bone at the anterior edge of the masseter muscle and also at, 
the side of the nose high up as well as near the corner of the mouth close to 
the mucous membrane. The coronarv arteries are readily felt by placing 
the finger just beneath the lip against the mucous membrane; you can feel 
them pulsate on the inner side of the upper lip and on the inner side of the 
lower lip. The facial vein, instead of taking a tortuous course to follow the 
artery, runs directly from the inner angle of the eye down to the anterior bor- 
der of the maseter muscles. 

III. Examination of the Eye: — I took this subject up at the last lec- 
ture, but there are some points that I wish to call to your attention in examin- 
ing the eye. An unnatural luster of the eye is seen in fevers. An unnatural 
brilliancy is found in consumptives. A glassy eye in children shows inflam- 
mation of the mesenteric glands, and if it is accompanied by dark, dry lips and 
tongue and great restlessness, it showns an acute inflammation of fthe stomach. 
In fevers glassy eyes are a sign of great danger or of some serious change about 
to occur. Dull eyes are noticed in febrile conditions, during the catamenia, in 
catarrhal and other affections. Sunken eyes are due to the absorption of the 
fatty cushions, and indicate some loss of the vital fluid; hemorrhage or some 
exhausting disease. Exophthalmus, that is protusion of the eye ball, when not 
congenital, is said to be characteristic of Basedow's or Graves' disease. 

In your examination of the eye you should bear in mind and see what parts 
of the eye are affected; whether it is the lid, iris or conjunctiva, whether it is a 



io3 tre:atment of the eye. 

change in the eye ball, whether the sight is affected, or there be a weakening of 
the nerves, or inflammation of the eye. 

IV. Treatment of the Kye: — As I have said, the treatment of the eye 
Osteopathically is quite a simple matter. There are certain points that I will 
go over to notice how we treat the eye. In the first place, as I noted, we some- 
times bring direct pressure upon the eye. We simply with one hand press gen- 
tly upon the eye ball, or you can lay your thumbs on it and press downward. 
In that way, as I explained to you, you probably have an effect upon the ciliary 
ganglion, you would also, of course, mechanically excite the blood supply b}^ 
pressure. You would also have an effect through this pressure upon the optic 
nerve, since all these parts by being pressed back into the cavity would be more 
or less impinged upon. I also noted that we sometimes gently tapped the eye, 
laying one finger upon the eye, and with another, tapping three or four times 
very gently. The idea in that is. Dr. Harry Still says, to shock the optic nerve 
and thus stimulate it. Of course in that way also we stimulate the sympathet- 
ic, and through them the blood supply. We frequently in treatment of the 
head tap upon the frontal sinus, not very hard, for troubles with a branch of 
the fifth nerve which supplies that sinus, and from it you might have a bad ef- 
fect upon the eye, causing some pain, which you might relieve in that way. 
We are frequently called upon to treat granulated eyelids. They are some- 
thing that are readily treated by Osteopathic means, and something which are 
very distressing to the eye. We just wet the finger with a little water or some 
oil, sweet oil or vaseline and press it under the edge of the lid, both above and 
below, and then pressing with the thumb against the outside of the lid upon 
the finger, work with the thumb and finger along the edge of the 
lid, and in that way you stimulate the local blood flow; and the 
thickening there causing the granulations is said to be due sometimes 
to a local hypertrophy of the conjunctiva, or sometimes to a stop- 
ping of the ducts of the Meibomian glands. In thus working 
you would stimulate the blood flow to make that conjunctiva normal or you 
would take awav the stoppage of the ducts of the glands. Sometimes the se- 
cretion gets thicii and stops up the ducts, I have often heard Dr. Hildreth 
speak of quite a noted case of granulated eyelids which were entirely cured. 
He said that Dr. Still explained that there was a stoppage of the circulation, 
that the blood had to make some use of the nutriment which was carried there; 
and instead of it being directed normally it was directed abnormally on account 
of the stoppage, and so caused these abnormal growths. What he did, was, 
as I have .said, to free the circulation. Of course in anj^ treatment of the eye 
we must work over the superior cervical ganglion to get our effect upon the 
circulation. 

I spoke about points at which we can reach the fifth nerve. Particularly 
in work upon the eye we work at the supra-orbital notch or foramen, here at 
the junction of the inner and middle third of the arch. Be careful to free that 
so that any contraction of the tissues about it are thoroughly relaxed. Then 



CKNTE^RS FOR PARTS OF THE HEAD. I07 

the same thing should be done below, at the infraorbital foramen. We also 
get a termination of the fifth nerve at the outer angle of the eye, and I always 
work carefully there and stimulate that branch of the fifth nerve. There is 
said to be a terminal branch just over the middle of the eye lid, and two ter- 
minal branches at the inner canthus of the eye on the nose, where we can read- 
ily impinge upon them. A terminal branch is found also upon each side of the 
mid-line of the forehead. According to the theory that we can work upon nerve 
terminals, as we frequently do, to gain an important effect upon the connected 
parts, we here have a number of terminal branches of the fifth nerve which we 
could certainly influence in that way to restore the normal. Of course at these 
places we also get the little blood vessels, here at the inner canthus and at the 
foramina and free them in our treatment. Another way that Dr. Harry some- 
times employs almost exclusively in work upon the eye is to have a patient spring 
the mouth open while you hold the jaw; the idea being to free the blood supply 
through the carotids, since the blood supply of the eye is deriyed entirely from 
the internal carotids, and it is a very important point in relation to work upon 
the eyes. Of course we must not forget the point I mentioned in regard to the 
neck, and which you are familiar with; but the great and important point upon 
which we work, always remember, is the superior ganglion. Thoroughly relax 
everything and remove every pressure which may affect the blood flow. I 
showed you how to inhibit the action of the cervical sympathetic by holding 
Of course stimulating would be the opposite — w^orking quickly with alternate 
pressure and relaxation. 

LECTURE XVIII. 

At the last lecture I took up points in regard to the eye, giving you various 
centers, which I need not repeat here. Also I noted the importance of the cil- 
iary ganglion in connection with the eye, the importance of the third nerve in 
relation with the eye; also of the fifth nerve in nutrition of the eye and parts of 
the head and face. Then I brought out certain points of importance to us 
as Osteopaths. I noted certain landmarks concerning the head and face; con- 
cluded the examination and took up the treatment of the eye. I wash to-day 
to continue our consideration of points about the head and face. 

I. Certain Centers FOR THE Parts OF THE Head: — I have already 
mentioned some in previous lectures. Howell's Text Book states that the cer- 
vical sympathetic contains vaso- constrictor fibres for the face, the eye, the ear, 
the salivary glands, the tongue, and perhaps the brain. As to vaso- motor 
nerves to the tongue; the lingual and glosso-pharyngeal nerves contain two 
vaso-dilator fibres, while the hypoglossal and sympathetics contain vaso-con- 
strictor fibres. The chorda tympani, as already noted, is the vaso-dilator of 
the submaxillary gland. Quain states that the secretory fibres of the stibmax- 
illary gland arises mainly from the second and third dorsal. Dana states that 
herpes, fltishing, pallor, lachrymatiou and salivation indicate some disturbance 
of the sympathetic and trophic fibres contained in the fifth nerve. Ouainstates 



I08 THE EYE. LANDMARKS. 

further that the glosso-pharyngeal nerve through its small superficial petrossal 
branch furnishes secretory and vaso- dilator fibres to the parotid gland. 

In view of these facts, and of facts which I have already presented, I wish 
to call the following points to your attention: First, that ^^ou have already been 
shown how to reach and treat the fifth nerve, the cervical sympathetic, the 
lingual, which is a branch of the facial, and the glossopharyngeal. I have 
brought up further the hypoglossal nerve, which is reached by the Osteopath 
at its exit from the skall at the anterior condyloid foramen, and also indirectly 
by the treatment of the superior cervical sympathetic ganglion. That the Os- 
teopath thus controls the nerve supply of all parts of the head practically, and 
through the nerve supply the blood to the head, governing as he does, b}' his 
work upon the neck, the blood flow to all parts of the head, he must have an 
important effect upcn nutrition. A further point is that the Osteopathic work 
is very simple, and is made up largely of treatment in the neck, particularly at 
the superior cervical ganglion. I say very simple, because it is so in certain 
respects, but very complex when you come to study out the various complex 
relations of the nerves and the effect we may get upon them by working upon 
centers. 

II. Landmarks: — Holden instances the foLowing points: The opening 
between the eyelids varies in size in different persons. It is this change, and 
not a variation in the size of the eyeball which makes us say a person has a 
large or small eye, as the eyeballs are very nearl}^ of the same size in different 
individuals. The external angle of the lid is generally a little higher than the 
internal angle, ^and gives an arch expression to the face. The clos- 
ed lids fit accurately together, and are not believed, as sometimes stated, to form 
a channel with the ball of the eye for the flow of the tears. Upon shutting 
the eye the ball turns slightly upward and inward, and in that way cleansing' 
the cornea uf any foreign substance which may have dropped upon it, and also 
turning the pupil away from the light. The puncta lachrymalia are familiar ta 
you, they are seen at the inner angle of each lid. The lachrymal sac is found 
b}^ drawing the eyelids outward, tensing in that way the tendo oculi, which 
crosses the lachrymal sac about the middle. By placing your finger upon the 
tendo oculi you can feel, by winking the e3^e, that the orbicularis palpebrarum 
and the muscles about the eye, keep that tendon working so that the tears are 
pumped into the lachrymal sac and passed into the nasal duct. The nasal duct 
is from six to eight lines long, and passes from the lachrymal sac downward. It 
opens at the top of the inferior meatus or sometimes in the outer wall. The 
left nostril, you will see upon examination is usually narrower thon the right, 
owing to a division toward the left of the septum. It is important to know these 
points, so that you will recognize the normal conditions and not confuse them 
with disease. The middle and inferior spongy bones may be seen by dilating 
the nostril and throwing the head back. They are red in color and must be 
carefully distinguished from polypi. 

The Osteopath should also note the color of the lips, the normal vermil- 



KXAM I NATION OF THE KYK. I09 

lion color indicating health, and a departure from this indicating either the 
state of the circulation or condition of the blood. In looking into the mouth 
always bear in mind to look at the condition of the tongue, as it is a great in- 
dicator of disease. Upon the under surface of the tongue is a median furrow 
upon each side of which is the ranine vein. In the middle line of the floor of 
the mouth is the frenum linguse, upon each side of which is the opening of the 
duct of Wharton, leading from the submaxillary glands, which you may find 
beneath the mucous membrane back near the angle of the jaw. The subling- 
ual glands are in the ridge of mucuos membrane each side of the middle. The 
shape of the hard palate is sometimes significant, usually a broad arch, some' 
times narrower at the top like Gothic arch, and it is said that in idiots it is 
quite sharp. 

In examining the throat it is a good plan, it is said, to hold the nose so 
that the person is obliged to breath through the mouth. That will cause a di- 
lation of the various parts of the throat and a widening of the fauces and a 
raising of the soft palate, so that you can then get a good view of the internal 
parts of the throat. When you depress the tongue it should be done gently 
with your finger or the handle of a spoon or something of that kind; if 5'ou 
are rough the tongue will resist the effort you are making to lower it. The 
operator can pass his finger down into the throat past the epiglottis as far as 
the inferior border of the cricoid cartilage; as far as the beginning of the oeso- 
phagus, and can make out the greater cornua of the hyoid bone and seek in 
the hyoid spaces on each side where any foreign body is quite apt to lodge. It 
is important to know sometimes that behind the last molar tooth there is a 
small aperature through which a little tube may be introduced through which 
to feed a patient in spasmodic closure of the lower jaw. The pterygo maxil- 
lary ligament is seen opposite the last molar tooth. The place where the sur- 
geon taps the antrum is just above the second bicuspid tooth about an inch 
above the margin of the gum. The aperture of the posterior nares may be 
felt by passing the finger carefully up behind the soft palate, and there can be 
made out by the touch the back of the septum and the back part of the infer- 
ior spongy bone in each nostril, also a grasping feeling from the action of the 
superior constrictors of the pharynx. 

I have already spoken concerning the tonsils. They lie at the side of the 
throat just behind the pillars, and in examination of the throat if you see them 
extending beyond those pillars, it shows they are abnormal in size. The nor- 
mal tonsil does not extend beyond the level of the pillars. 

I have mentioned physiognomy in relation to examination of the face. It is- 
stated that the insertion of the muscles, not only into tendons and bony parts 
of the face, but also into the skin all over the face, leads to the formation of 
lines. That the passage of various thoughts through the mind constantly re- 
curring, calls into play certain sets of muscles, and finally leaves lines upon the 
skin at the places of contraction, thus creating a reliable method by which the 
countenance may be read, and which is sometimes useful to us. There are twa 



no EXAMINATION OF THK EAR. 

of these lines which I wish to mention particularly. Fir*^t, there is the linae 
nasalis, extending from the alse nasi out to the angle of the mouth. , And it is 
said in children its presence denotes some abdominal trouble, especially inflam- 
mation of the bowels; in older persons some trouble with the stomach, or ab- 
dominal disease, frequently of the liver. The linae labialis extends from the 
angle of the mouth down to the side of the jaw. It is seen frequently in chil- 
dren with inflammatory diseases of the larynx or lungs, and in older people 
who have laryngeal and bronchial trouble, and difficulty of breathing-. Of 
course the Osteopath, as well as the physician, should become familiar with the 
indications of the face, know its natural temperature and different things about 
it. I cannot mention such things now, but they are interesting to stud}'- and 
are very practical in directing the operator's attention to the probabilities of di- 
disease — it is very helpful in diagnosis. 

I wish today to examine further the parts of the head, and show 3^ou the 
treatment to be given. 

III. Examination of the Ear. The disease may be in the external, in 
the internal, or in the middle ear, or it may be in the brain or in the auditory 
nerve itself. It is sometimes very difficult to say where the location of the 
disease is. First: As to examination of the external auditory canal. Since 
it runs forward and inward and is slightly curved, you must draw the auricle 
upward and backward to be able to look down into the external canal. You 
must have a good light. You can look directly in without the aid of any in- 
strument, but usually the operator should be supplied with an ear speculum, 
which is a little tube, funnel .shaped, polished so as to reflect the light. Fre- 
quently a forehead mirror is used; a little mirror that is fastened by a band 
about the forehead, with an aperture in the middle, through which the oper- 
ator may look. This reflects the light, and reveals the interior of the canal. 
In looking into the external ear you may notice that there is too much or too 
little wax, indicating some general disease. You may notice that there are 
growths in the ear, or foreign bodies, such as buttons in children's ears, or 
insects, or the wax may become hard and impacted. I had a case once in 
which a person had noticed a slight deafness, continually increasing until fin- 
ally he was not able to hear his watch tick when held at his ear. I found by 
-examination that the wax had become impacted. Of course he could hear in- 
ternally by certain methods employed to test the hearing. I just took the 
■curved end of a hair pin and picked out the wax, and he could hear all right. 
It is quite a common thing in persons who have a poor quality of blood to have 
furuncles, or boils, in the external auditory canal. Your examination of the 
■ear will reveal to you the membrani tympani, which should appear concave. 
It is in color a pearly gray and glistens with the reflection of the light. You 
can see the processus brevis of the malleus and the manubrium of the malleus, 
and you can, sometimes, with a good light, see the processus longus of the in- 
cus. The membrane appears concave, the most concave part at the end of the 
manubrium, is called the umbo; at the tip of the manubrium appears a bright 



TRtiATMENT OF THE EAR AND NOSE. Ill 

triangle or pyramid of light where the reflection is brighter than at other parts. 
Of course only practice will make you familiar with the normal external parts 
and appearance of the membrane. Further, you should always in examining 
the ear look for perforations, of the membrane because those frequently occur 
in ear troubles. 

As to the middle ear, you may have it affected by different diseases, 
among which are inflammations, catarrhs, etc.,. in which case pus or mucus 
may collect in it. In that case, if the ear were filled with pus or mucous, the 
membrane would be pushed outward, and would be convex instead of concave. 
By examining from the external ear, if inflammation were present there would 
be a reddish appearance of the membrane. It is said the presence of mucus 
or pus gives a yellowish tinge to the membrane. For examination to see 
whether or not the Eustachian tube be closed there are different methods used. 
One is for the patient to close his nose and mouth and make an expiratory ef- 
fort, eliciting a crakling sound of the membrane, due to the impact of the air. 
That is called Valsalra's method. Another method, called Politzer's. is prac- 
tically the same. The patient is directed to swallow a little water, the opera- 
tor having introduced a tube through one nostril, and closing the mouth and 
both nostrils except the tuhe, through this tube the operator blows, and the 
air is forced up toward the membrane, and in case the membrane is perforated 
there is a whistling sound as the air escapes. Or if there is an accumulation of 
pus or fluids, they will be driven into the external ear. In case of closure of 
the external ear it is said that there is a magnification of the sound in the mid- 
dle ear, or in case of closure of the Eustachian tube the same thing would ob- 
tain, or in case there was too much secretion about the ossicles, not allowing 
free motion. In such cases it is against the teeth, the sound is increased in the- 
affected side. If it is heard louder in the other ear, it indicates some trouble 
with the internal ear of the affected side. Your diagnosis may be made still 
closer by placing a watch or tuning fork against the mastoid process of the af- 
fected ear; if there is no response you may be sure the trouble is in the internal 
ear. Those are a few methods by which you may determine where is the 
trouble that is affecting the ear. Since the aurist makes the ear his life time 
work, we cannot do justice to the subject in any one or two lectures. 

IV. Treatment of the Ear — I have already shown 3'ou how to ex- 
amine the external canal of the ear; the usual methods are employed to remove 
foreign substances, or in case of impacted wax you had better u^e some warm 
water; it may take several sittings to remove it entirely, and the hearing may 
be worse after the first treatment with the water because of the swelling of the 
wax filling the canal. In the case of insects in the ear seme waim water or 
sweet oil may be introduced with a syringe. In ear aft'ections there is usually 
trouble with the atlas or in the upper cervical region. We treat then the lesion 
if we find it, in the neck, and we treat the ear largely by regulating: the bleed 
supply; by springing the jaw, as already shown. The chief work in the neck 
is on the superior cervical ganglion, and in stimulating the blood flow through 



112 TREATMENT 01! NOSS AND THROAT. 

the carotid arteries. Of course in affections ot the ear from catarrh or consti- 
tutional troubles 3^ou would have to direct your treatment to the general con- 
dition of the patient — look after his general health. I had an interesting case 
of deafness once where I did not treat the ear at all. I found the clavicle was 
slipped; that the scaleni muscles were hard; that there was a paresis of the right 
arm. I slipped the clavicle back, treated the scaleni muscles, and the lady 
went up stairs and immediatel}* called dow^n that she could hear the clock tick- 
ing downstairs, something she had not done before. It must have been by 
S3^mpathetic connection of the nerves which had been affected; the brachial 
plexus and the nerves to the ear. I do not know of any other wa}^ to account 
for it. ' That shows you cannot always work according to rule, but you must 
look for the cause and treat wherever that may occur. 

Examination and Treatment of the Nose:— Since the aperture of 
the nostril is on a little lower level than the bottom of the passage of the nostril, 
3'ou have to pull the nose up and back. You can dilate it with a speculum 
used for the purpose, and you can use either form of reflected light. You may 
see the middle and inferior turbinated bones and the marks I have mentioned. 
You will learn to recognize the normal conditions, and to note any diseased con- 
ditions and observe whether there are any growths in the nose; the polypus is 
the most common. It is common to meet with fractured nasal bones. That 
of course belongs to the surgeon, but is very readilj^ set. You can diagnose 
this condition by holding the ear close and you can hear a grating sound as you 
move the nose. I have had cases in which I would simply straighten out the 
parts, using no splint or anything of that kind. I do not know what is the 
usual method surgically, but with no splints the bones wall stay in position and 
no deformity or abnormality follow. You will sometimes notice that in catarrh 
on account of the absorption of these turbinated bones, the nose is deflected to- 
one side or to the other. The usual way in which we treat the nose, aside 
from the general system which is adopted in catarrh, the freeing of the blood 
supply in the neck and of the blood supply about the nose, is to work on the 
outside of the nose and loosen all the tissues along the side. In that way also 
you free the nasal duct by loosening all the tissues. Also in case of stoppage 
of the nose in colds and catarrh, we place the hand fiat above the frontal sin- 
uses and press down quite hard. You can sometimes clear the nostrils in that 
way so that the stoppage is gone and the breathing is clear through the nos- 
trils. There is another disease w^hich you frequentl}^ meet, a ringing in the 
ear, tinnitus rurium. It is common in old people, and it is common also in 
constitutiotial diseases, after sunstroke, or in malnutrition, and old age. There- 
fore, it arises sometimes from conditions of general health. The Osteopath 
has found that it is due, in some cases, to a stoppage of the circulation m the 
little anastomosis on the ear drum, and he then works in the usual method to 
free up the carotid artery, and by stretching the jaw. Sometimes the trouble 
is in an obstruction to the auditory nerv^e. It is said that we inherit the audi- 
tory nerve by pressure in the neck opposite the third cervical, by steadily hold- 
ing there. 



THE SPLANCHNIC NERVKS. II3 

I cannot mention in such a lecture as this all the points in connection with 
examination of the mouth and throat. That also is a field for the specialist. I 
have noted that you should seethe condition of the tongue, whether it is furred, 
what its teaiperature is, and its color. These are very indicative. For instance 
it is said a tongue furred on one side is indicative of a one-sided disease, as for 
instance, of the liver or spleen. A furred tongue has been noticed by Hilton 
in a case of ulceration of the teeth. The half of the tongue on the side of the 
mouth affected by the tooth was furred, and there was stiffness of the jaw. Of 
course he referred it to the fifth nerve, which supplies the muscles of the jaw 
and supplies also a part of the tongue. As to the color of the tongue, we 
might mention for instance, the strawberry tongue, as it is called, in scarlet 
fever, or the lead colored thrush-covered tongue in the dying. 

You wuU observe the tonsils, the uvula and the condition of the fauces. 
Frequently in diseases of the throat the uvula is inflamed or edemetous and is 
hanging down, obstructing the passage of the air, and keeping the patient con- 
tinually coughing. There are certain times when we give internal treatment 
to the mouth and throat, but not very frequently. That is, in case of catarrh, 
tonsilitis, or something of that kind. We sometimes insert the fingers and by 
a pressure upward and outward along the pillars of the fauces, we free the 
circulation to those parts, and can in that way to a considerable extent allay 
the inflammation. That is, we frequently relax congested and contracted 
parts. The general treatment for the throat I have shown you, by loosening 
the muscles and by working to free the blood suppi}^ but you must also be sure 
that all the muscles throughout the neck are relaxed. You can feel those in the 
back of the neck, as I have already shown. You cannot, however feel the anterior 
spinal muscles in the neck, you must take into consideration the probability^ 
that^where others are contracted, they also are, and adapt 5'our different 
motions to the stretching of those muscles; simply b}^ stretching the head back- 
ward you can free all the branches of the nerves. 

There is a great deal more that might be said both in general and in parti- 
cular concerning the eye, nose, throat, and parts of the head, but I think that 
in three lectures that I have given you I have been able to give you the usual 
Osteopathic treatment for the parts of the head, and to give a general idea 
of the importance of these things. Of course we depend entirely upon the 
nerve and blood supply. That after all is the best part of the work. 

O. In regard to examination of the nostril, you said we should observe 
the turbinated bones. Is there any way by which you can remove abnormal 
growths from that bone osteopathically^ 

A. That bone is very frequently softened by catarrh, sometimes tilcerated 
and eaten away, and in so far as yoti can influence catarrh, with which we have 
good results, you could influence this other trouble, and by work upon the nose 
you might gradually work the parts back into their normal condition. 

O. You spoke of dropping of the uvula, is that not caused largely bv 
catarrh? 



114 'I'HE SPLANCHNIC NERVES. 

A. Yes, sir, in general. Anything which would inflame, of which 
catarrh is a sample. 

LECTURE XIX. 

At the eighteenth lecture I considered certain Osteopathic points about the 
head, giving you certain centers for the head and its parts, which I need not re- 
peat here; something concerning the vaso motors, that the Osteopath had there- 
fore a good field upon w^hich to work in treatino: the head and all its parts, the 
brain included. I then instanced certain landmarks, and took up further the 
subject of how to examine the parts of the head, including the eye, nose, throat 
and mouth. I wish to day to call your attention further to the thorax and its 
parts. We have so far in our Osteopathic work seen how to examine the spine, 
neck, head, etc., the significance of points discovered; also how to treat them. 
It is of great interest to us now to go to the thorax. And in going to the 
thorax it is quite fitting that I should say something in particular about the 
splanchnic nerves. I have said something concerning these nerves already, but 
think something more in particular would be of value to you. The splanchnics, 
as you probabl}' already know, are some of the most important tools with which 
the Osteopath works and I will venture the asserrion that there will be hardly 
a day in your practice pass without your working upon the splanchnics. They 
are of such far reaching connection that their importance at once becomes ap- 
parent, hence, their constant use by the Osteopath. As to definition, you 
know what splanchnology is — the science of the viscera. Hence, the splanch- 
nics, refers to visceral nerves, those nerves governing the viscera, and it is in 
this fact that their significance lies. It is with the sympathetic splanchnic 
nerves that we as Osteopaths have to deal, and it is because of their fair reach- 
ing control of visceral life and the wonderful results the Osteopath can get in 
working upon them, that he has been so successful in treatment of diseases in 
general. That is one of the reasons, I should say. 

Now, as to what these nerves are, we know^ at once that they are the 
sympathetics from the lateral chains of thoracic ganglia. I want to bring out 
a few points concerning these nerves by way of review, so that we will know 
what we are working with. First, the great splanchnic arises from as high as 
the fifth or sixth, and from all of the thoracic ganglia below down to the ninth 
or tenth. It perforates the diaphragm and joins the lower part of the semi- 
lunar ganglion. In the chest it sometimes divides and forms a plexus with the 
smaller splanchnic. As to the nature of these fibers, they are white, medul- 
lated fibers. You remember in one of the first lectures I called your attention 
to the fact that in the sympathetic there are two kinds of fibers. And it is 
stated by Quain that about four-fifths of the fibers of the splanchnics are made 
up of white medullated fibers, and they come direct from the anterior roots of 
the spinal nerves. This greater splanchnic may arise as high as the third 
thoracic. Gray, I believe, states it may receive branches from the upper six 



THE SPI^ANCHNIC NERVES- II5 

thoracic. This greater splanchnic gives branches to the aorta itself and to the 
front of the vertebrae. 

As to the smaller splanchnic, it arises from the ninth and tenth, as usually- 
described, sometimes from the tenth and eleventh, thoracic ganglia. Or, it 
may not arise from the ganglia, it may arise from the sympathetic cord itself 
without the intervention of ganglia. It also passes through the diaphragm, 
sometimes separately, and sometimes in conjunction with the cord of the 
greater splanchnic. It also joins the lower part of the semi-lunar ganglion, 
and sends branches to the renal plexus in case the renal splanchnic is wanting, 
or in case it is small. 

The smallest or renal splanchnic, as you gather from the above, is some- 
times wanting. It arises from the last thoracic ganglion, and passes through 
the diaphragm in connection with the general sympathetic cord, and goes to 
the renal plexus, not the semi-lunar ganglion. 

A fourth splanchnic is sometimes described. It is stated that Wrisberg in 
eight instances out of a great many found a fourth splanchnic in the cervical 
region. 

We all understand what is meant in general when we speak of the splanch- 
nics. That is, these three splanchnic nerves. But you will see that it is 
sometimes used in a different sense. Gaskell, quoted by Quain, says that there 
are visceral branches from the second, third and fourth sacral nerves, and 
these he calls the "sacral or pelvic splanchnics." "The cervicocranial rami 
viscerales" are visceral branches from the spinal accessory, pneumo^astric and 
glosso-pharyngeal and facial nerves. So you see that visceral nerves have their 
origin from these cranial nerves; also a branch from the ciliary ganglion from 
the third nerve. Byron Robinson has this to say concerning splanchnics in 
general. "There are certain fine white medullated nerves, which Gaskell 
mentioned, and which pass from the spinal cord in the white rami comniuni- 
cantes between the second dorsal and second lumbar nerves inclusively, to sup- 
ply viscera and blood vessels. These nerves should be called, as Gaskell sug- 
gests, splanchnics. Hence, we will have, first, the thoracic splanchnics: second, 
the abdominal splanchnics, and third, the pelvic splanchnics. Hence, you will 
see the general use to which Gaskell put the term, in the use of which the 
other authorities have concurred. Robinson says further, that these white 
rami communicantes extend from the second dorsal to the second lumbar, but 
we know that along this region and in the region above the second dorsal and 
below the second lumbar, gray ones are found. In the last two named regions 
gray exclusively. That variety he calls peripheral, supplying the parties of 
the body. From the foregoing, and what has been said in general concerning 
splanchnics, we see that the splanchnics proper of which we speak, are white 
medullated fibers, for the most part, and that their particular function is to 
attend to the blood vessels and to the viscera. Flint says that the splanchnics 
are the most important vaso-motors of the system. And further, Ouain states 
that the medullated fibers, that is, such as we find in the splanchnics, which 



Il6 RKGULATIVK KFFKCTS OF WORK UPON THE SPLANCHNICS. 

pass in the sympathetic system, are classed by Kolliker as (a) sensory, (by) vaso 
and viscero-constrictors, and (c) vaso and viscero-dilators. Hence, we have 
passing from the spinal cord along into the great prevertebral plexuses in the 
different regions these sensory, vaso-dilators and contrictors and viscero inhib- 
itors and constrictors. He goes on further to say that the sensory are found 
only passing from the cranial nerves, but that these visceral and vaso-motor 
fibers are found all the way down the cord. Hence we see at once that these 
visceral and vaso-motor fibers are found in the splanchnics. In line with the above 
Quain says further, that the splanchnic nerves proper, act first, as viscero- 
inhibitory fibers for the stomach and intestines; second, as vaso-motor fibers to 
the abdominal blood vessels; third as afferent fibers from the abdominal viscera. 
That is, fibers from the adbominal viscera back to the center. And that 
explains whj^ it is that we get secondary lesions, as we call them. You may 
have some trouble in a viscus somewhere, and knowing that 3'ou have afferent 
fibers from the viscus back to the center, you can account for the center being 
affected, and the impulse coming out from it to the posterior spinal nerves, for 
example, and causing contracture of the muscles in the back. I have already 
said enough to show you the importance of the splanchnics — to show you in 
general their nature and function. They become still more significant to the 
Osteopath when he considers their connections with the other parts of the 
sympathetic system. In the first place, they must be connected with the spinal 
cord itself, since they arise from the anterior roots, and, through the cord, with 
tiie brain. It is doubtful how close a connection they have with the brain 
centers, but they have at least a close connection with the bulbar center, the 
vaso constrictor center of the medulla. Then it is probable that these splanch- 
nic have a close connection also with cardiac and pulmonary fibers arising from 
the upper part of the spinal cord; because we have seen that the center for 
the lungs extends from the second to the seventh dorsal, and that we work in 
the upper dorsal region for the heart, and there are certain vaso motor fibers 
from these regions to the heart aid lungs, so that it is almost undisputable that 
there is a connection between the splanchnic and what we might call other 
splanchnics for the heart and lungs. In ihe next place, we have seen that the 
first two splanchnic nerves join the semilunar ganglion, and third the renal 
ganglion. And they are connected directly with the solar plexus, and through 
it with the other great prevertebral plexus, the hypogastric plexus, and 
through that with those little secondary plexuses, such as the superior and 
inferior mesenteric, hemorrhoidal, portal, Auerbach's and Meissner's, and the 
various plexuses throughout the pelvis and elsewhere Hence, an5^one who 
sees the significance of osteopathic work will see the significance of this far 
reaching connection with visceral and organic life. Then, again remember, 
that in the thorax the first or greater splanchnic sends branches directly to the 
aorta itself. Hence it is that the operator so frequently works upon the 
splanchnics; it does not make any difference what kind of trouble you may have, 
your general health is likel}^ to be affected, and it must be attended to; and 



RKGULATIVK KFFECT OF WORK UPON THE SPI.ANCHNICS. II7 

whether you are working upon the stomach, liver, portal system, upon the 
intestines, or pelvic viscera, you will work, at least in part, upon the splanch- 
nics. 

There is a second sense in which we must consider the use of these splanch- 
nic nerves, and we may state the matter this way: That work upon the 
splanchnic nerve is frequently a regulative process. I might illustrate what I 
mean by that. Here you have a set of sympathetic nerves, they are vaso-motor 
nerves for very important parts of the body, viz: the internal viscera, which 
receives an exceedingly large blood supply. If the osteopathic ability to work 
upon the nerve centers and nerve connections stands for anything, it must ecr- 
tainl}^ stand for something^ when it goes to work upon these splanchnics Hence, 
he must have a large control throughout a great portion of the circulation of 
the body since it is so richly supplied from these nerves. Here you have a 
quantity of blood in the body; we will say in a certain case it is unequally di- 
vided. The Osteopath's work is sometimes to equalize the circulation through- 
out the body. In case you have a headache, which is frequently a congestion 
in the cranium, what do you wish to do? You wish to regulate the circulation. 
You must therefore employ some regulative process, and very frequently we 
work upon these splanchnics to throw this congestion somewhere else where it 
will do no harm. Another thing, the most natural place for the overplus of 
blood to go is in the abdominal veins. Green makes the statement that the 
abdominal veins are the most easily dilated, and while I cannot exactly quote 
from him, I belie v^e he goes on to say that the overplus of blood is most read- 
ily thrown there. At any rate I can state it is my experience that we can get 
important results by throwing the congested blood to the abdominal veins, and 
we do cause another congestion there. Not long ago I had a case of headache; 
it came from prolapsus. The lady had vomited, and had had trouble with her 
stomach and trouble generally. I gave the usual treatments, as I always do 
first, working about the region of the stomach and liver and over the splanch- 
nics, as it looked as if the case at first might be a case of sick headache, later 
she told me it was from prolapsus. I then treated all about her head, but the 
headache did not go until I finally pressed deeply over the region of the solar 
plexus. By deep pressure there until you can feel the pulsation of the abdom- 
inal aorta, you will get important results verj^ frequently. In other cases I 
have relieved headache by simply pressing there. Now, whether that was 
simply inhibition over the solar plexus, and thus to the brain, and thus quiet- 
ing the painful senses, I could not say, but it looks to me more likely that it 
was a regulative process which inhibited the solar splanchnic and allowed the 
blood to couiC to the veins of the abdomen, and thus relieved the congestion in 
other parts. There is another thing that I frequently notice in my practice, 
that is I get effects upon the circulation of the body by a general spinal treat- 
ment, which of course involves work upon the splanchnic region. And I can, 
by working there, coupled with the usual treatment I give the heart, get better 
results in quieting the pulse than I can by other methods. It seems to me it is 



Il8 LANDMARKS FOR THE THORAX. 

because I get a dilation of the vessels in general throughout the abdominal 
viscera, hence lessening of the tension and slowing of the blood flow follows, 
and a quieting of the pulse. A case of the same kind might be mentioned 
where a congested uterus was relieved by work over the splanchnic region. 
How we reach and treat that region I will show you in detail in the third part 
of the lecture. 

In line with what I have stated, Howell's Text Book says that "vascular 
changes produced reflexly in the splanchnic area are of especial importance be- 
cause of the great number of vessels innervated through these nerves, and the 
great changes in blood pressure that can follow dilation or constriction on so 
large a scale." Someone asked me some time ago how we worked to cure a 
cold. I told him that was a matter of general treatment which I shall take up 
later. However, we give a spinal treatment, drawing the congestion from the 
part affected, which is very frequently the head, and give relief. That is, we 
work upon a large amount of blood controlled by the splanchnics, and thus 
draw it away from the congested part. We thus see that it is a very probable, 
and, in view of the facts it is quite likely the case, that the Osteopath can al- 
most at will throw large quantities of blood to the abdominal region, or away 
from it, by proper treatment. I might state in passing that it is a principle of 
which we might take notice, that in a case of congestion it is a good plan to 
divert the congestion to some other part where it will do no harm. We stated 
the other day when the ma<"ter was brought up that the way to treat it was to 
sweep it out by freeing the arterial blood flow to the part. I am indebted to 
Dr. Conner for the suggestion that it is well to divert the congestion to a part 
where it will do no harm. [ saw him treat a case some time ago, an old ladv 
with a very troublesome cold in her head, which gave her headache and caused 
her a great deal of trouble. She had been treated for some bronchial trouble, 
and the pain had left the upper part of the chest and she thought the conges- 
tion had been forced into the head. Several had treated the case unsuccess- 
fully. Dr. Connor just came in and raised the clavicle and twisted the arm a 
time or two and went out. I saw him later in the hall and asked him about it. 
He said "I just lifted that clavicle and sent the congestion do^vn the arm where 
it would do no harm." I think we very frequently use the method and throw 
the blood somewhere else, but when it is thrown somewhere else I do not 
believe it is congestion. Howell's Text-book says further: ''Anemia or 
asphyxia of the brain stimulates the cells composing the center, that is the 
vaso-motor center, and more blood enters the cranial cavity whce it is needed. 
Doubtless the splanchnic area plays an important part in this restoration pro- 
cess." Hence we see from that, in the first pia-^e that the Osteopath may by 
his appropriate methods influence the blood in the splanchnic area by work 
upon the vaso-motor area in the medulla . And since it is a poor rule that will 
not work both ways, he can do the reverse. That is, he can affect blood flow 
in the head by work upon the splanchnic direct. Our conclusions may be ex- 
pressed under two heads: First, that in work upon the splanchnics the Ostec- 



I^ANDMARKS. EXAMINATION OF THK THORAX. II9 

path works upon them for the effect that it gets upon the connected viscera 
supplied by those splanchnics. That he works upon them in a secondary man- 
ner frequently for regulation of blood currents to the body generally or in 
some particular part of the body. 

II. Landmarks: — (According to Holden:) Since the heart and lungs 
are contained in the thorax, and since abnormalties of the parts of the thorax 
may cause serious troubles with these important viscera, and since the Osteo- 
path finds so many things upon which to work about the thorax I hardly need 
to say to you that it is important that we know the landmarks of the thorax 
thoroughly. I have given you some in connection with the spine, but you will 
notice the following: As a rule the right side of the chest is a little larger 
than the left and you should bear that in mind in making your examination. 
In the female the sternum is shorter and the upper ribs are more movable, and 
the upper aperture of the the thorax is on a level with the second dorsal verte- 
bra, is quite narrow, rarely exceeding two inches. Behind the first bone of 
the sternum there is no lung tissue. The left vena innominata crosses behind 
the sternum about an inch below the top. Next come the great primary 
branches from the aorta. You get deeper in this region the trachae bifurcation 
at about the level of the junction of the first and second parts of the sternum: 
and deepest of all lies the oesophagus. On the bifurcation of the trachea and 
about an inch below the upper margin of the sternum lies the highest part of 
the arch of the aorta, which curves on over the left bronchus. The course of 
the innominate artery corresponds to a line drawn from the middle of the junc- 
tion of the first and second bones of the sternum to the right sterno-clavicular 
articulation. All these are interesting to know. Here is something that is ab- 
olutely essential to know: 

Rules for counting the ribs: In passing your fingers down the sternum in 
front you can readily detect where the first part ends and the second part begins. 
Here is the junction of the cartilage of the second rib with the sternum. The 
first rib is found by feeling behind the clavicle above. You can by deep pressure 
come to the first. The first and second ribs give a great deal of trouble, and it 
is important to keep in mind this rule to find them. In the male the nipple is 
usually between the third and fourth ribs, three quarters of an inch external to 
the line of their cartilages. It is said that the lower external border of the 
pectoralis major corresponds in direction with the fifth rib, that a horizontal 
line drawn from the nipple right around the body will cut the sixth intercostal 
space at a point midway between the sternum and the spine. When the arm is 
raised the highest visible digitation of the serratus magnus corresponds with 
the sixth rib, and the seventh and eighth digitations correspond with the 
seventh and eighth ribs below. I have already noted that the scapula lies on 
the ribs from the second to the seventh inclusive. The eleventh and twelfth 
ribs are readily recognized, even in fleshy persons, at the outer edge of the erec- 
tor spinae, sloping downward. The sternal end of each rib, of course, as you 



I20 EXAMINATION OF THE THORAX. 

know, is lower than the end which joins the spine, and it is said that if a hori- 
zontal line w^as drawn from the middle of the third costal cartilage at its junc- 
tion with the sternum, it would touch the body of the sixth dorsal vertebra. 
The end of the sternum is upon a level with the tenth dorsal vertebra, its 
length varying some in different individuals, more in females than in males. 

III. (a) How TO Treat THE SPI.ANCHINCS. (b) How to Examine the 
Thorax: — There are various ways in which we may treat the splanchnics. 
One of the best ways to treat the splanchnics, especially the renal splanchnic, 
is to have the patient on the back, everything being relaxed. If you are afraid 
that the psoas muscles will not be relaxed, you can raise the limbs, and then 
everything will be. And then, by reaching under and raising the patient on 
the tips of the fingers, we get one of the most important effects upon the splanch- 
nics, especially the renal splanchnics. Dr. Harry treats in that way almost en- 
tirely for the kidneys. We may also treat the splanchnics by having the pa- 
tient on the side and springing up the spine all the way along the region of the 
splanchnics. Also, one way you can work is by loosening up all of these mus- 
cles, or you might have the patient upon the face and work as I have already 
shown you, and this, restricted particularly to the splanchnic region, will stim- 
ulate the splanchnics. There is one more important way in which we reach 
the splanchnics, and it is something we apply usuall}^ to the treatment of the 
liver, which of course must be done directly over the splanchnics. In treating 
the liver I alwaj^s end up in this way, reaching over with the left hand I get it 
against the angles of the right ribs, bent in this way to make a fulcrum of the 
hand. Then, having hold of the arm of the patient just below the elbow, I 
push it up and back and near the head and then backward; that raises the ribs, 
and of course it gets an effect also upon the splanchnics, that is directly; it will 
also act mechanicall}' in freeing the ribs here and give the liver more space in 
which to work. Once more as to how we can reach the splanchnics in front. 
This is the motion I use just here at the front; deep pressure until you can 
feel the abdominal aorta. It is apt to hurt some patients quite a little, you 
will have to be ver}' careful, some it will not hurt much, and if you do it gently 
and have quite a prolonged pressure there, you can often get the most astonish- 
ing results. It is said also that this pressure treatment here is very good to 
condense gas in bloating of the abdomen. 

As to the examination of the thorax, it is quite a long question, and I will 
have to let some of it go over until the next lecture, but I might call your at- 
tention to the importance of making very careful examination of the thorax. 

In examining the thorax you should have the patient lying flat upon his 
back. First, remember that the right side is usualh' a little larger than the 
left. You should by inspection, next the skin if possible, see that both sides 
are about the same size — that one does not bulge more than the other. You 
will find important changes in the shape of the thorax. For instance, I saw a 
case of enlargement of the heart from cigarette smoking; there was a percepti- 
ble bulge in the precardial region. In another case of asthma, I saw quite a 



EXAMIRATION OF THE THORAX. 121 

bulge Upon the right side under the region of the upper ribs. Also see that 
when the patient is standing the thorax is in shape; that is, that one side is 
not dropped more than the other. Sometimes we will find one side of the thor- 
ax dropped. It is proper in making your examination, especially by palpita- 
tion, to put both hands upon the part, so that you involuntarily compare the 
parts. If I were examining this thorax upon the leftside particularly, I would 
put my left hand upon the side opposite, so that I could compare the parts as 
I work over it. 

Of course to examine in front and behind. Then you put your hand over 
the surface of the skin to detect any departure from the normal temperature. 
I have already noted the importance of that in examination of the liver; in 
conditions resulting from diseased liver it is said that very frequently cold spots 
are found upon the surface of the body. However, you will have to be a little 
careful on a warm summer day, a person being in a state of perspiration the 
skin will cool very rapidly. You should observe the shape of the thorax — 
whether the general shape be normal. In an infant yon will find it cylindrical, 
In asthma and emphysema you will find the characteristic barrel-shaped chest. 
In what is known as the paralytic chest the antero-posterior diameter is lessen- 
ed and the chest is flattened. I have -already mentioned that to you in cases of 
neurasthenia, The rachitic chest is flattened upon the sides. Also look olOvSely 
at the sternum. It may be abnormally protruded or retracted, or there maybe 
malposition at the junction of the first and second parts, and the ensiform ap- 
pendix may be deflected to one side. 

Finally, look at the clavicle and the coracoid process. You know where 
to find the coracoid, on the front part of the shoulder at the origin of thecoracc- 
brachialis muscle. It is easily found. Sometimes fibers of the deltoid get caught 
below it, sometimes fibres of the brachial plexus. The clavicle ma}^ be up or 
down at either extremity. You will acquaint yourself with the normal feeling 
here at the junction of the clavicle with the scapula and will readily detect when 
it has slipped up or down. You can also see if it has slipped down by seeing 
whether it is close to the coracoid process at the scapular end, you will recog- 
nize whether it corresponds with the normal. At the upper part of the ster- 
num, the clavicle sets up quite prominently. It may slip down or be too high 
up, and you must learn to look for these things carefully. 



LECTURE XX. 

At the last lecture I considered especially the sp.anchnic nerves, showing 
you their origin, that they arise from as high as the third dorsal down to ^hc 
twelfth; that they were composed, largely at least, of white medullaied hoers. 
that they were closely connected with the cord, since they arise from the spinal 
nerves themselves, and wnth the various viceral plexuses, also, which rule or- 
ganic life; that they were extremely important in the work of the Osteopath, 
and that since the oreneral health was so often involved in the troubles of the 



122 LANDMARKS OF THE THORAX. 

viscera, therefore he worked upon them very frequently; the fact that he work- 
ed usually directly for the benefit of the action he would get up on abdominal 
life, and that also he frequently worked in a regulative way, using the splanch- 
nics for vaso-motor control largely, thus influencing large quantities of blood 
and drawing them from parts of the body where a congestion may have existed. 
I spoke in general also concerning congestion, and the way we treat it. I also 
brought out certain landmarks concerning the thorax and certain points in ex- 
amination of the parts of the thorax. I wish to continue that subject today. 

I. Landmarks of the Thorax: — After Holden: The interval below 
the clavicie is the sub-clavicular space between it and the upper margin of the 
pecloralis major and the deltoid externally, and is important as a guide to us 
to find the coracoid process. By drawing the arm up and backward in this 
way thus tensing those muscles we can find the subclavicle space, and at the 
outer part near the shoulder, we can find the inner side of the coracoid 
process. Also that space corresponds in direction to the direction 
of the axillary artery,^ we can feel it pulsing there, and can compress 
it against the second rib. The internal mammary artery runs perpendicular 
to the cartilages of the ribs, and about half an inch external to the margin of 
the sternum. Its perforating branch at the the second intercostal space, is the 
chief one. It becomes important for us Osteopaths in examination of the heart 
to know just what its topography upon the chest wall would be. The follow- 
ing description of the outline of the heart on the chest wall is given: 

That the base corresponds to a horizontal line drawn from the third costal 
cartilages, their upper border, extended a half inch to the right and an inch to 
the left; that the apex is found by measuring one inch internal and two inches 
below the nipple, this point being between the fifth and sixth ribs; that the 
lower margin ma^^ be outlined by drawing a line from this point of the apex; 
bulging slightly downward to the end of the sternum, the xiphoid cartilage 
excepted, that line extended as far as the right edge of the sternum; that the 
right border would therefore be indicated by a line joining a point at the right 
inferior extremity of the sternum with a point on a level with the cartilages of 
the third rib, extended half an inch to the right, while on the left the border 
would be indicated by a line drawn from the left extremity of this line at the 
base, an inch from the sternum on the level with the third costal cartilage down 
to the point which indicates the apex. In that way 3'OU would get the outline 
of the heart upon the chest wall. It is said that a needle passed into the third, 
fourth and fifth intercostal spaces on the right side just next to the sternum, 
would perforate the lung, pericardium, and the right auricle. A needle passed 
into the second interspace would perforate the aorta at is greatest bulge; also 
the part of the percardium which is reflected over the first part of the aorta. 
And that a needle perforating the first intercostal space on the right of the 
sternum would enter the superior* vena cava. 

This rule is given for finding the extent, or outlining in general the dull- 
sounding space in the percardial region made by the presence of the heart; take 



EXAMINATION OF THE THORAX. 1 23 

a point midway between the nipple and the sternum, a point midway for your 
center, and describe about that a circle with a diameter of two inches, and that 
will include practically all of this dull -sounding region over the heart. 

The apex of the heart, as you know, beats between the fifth and sixth ribs. 
Its impulse is readily felt there, but that is not an invariable place to find it. 
You can change the position of the heart by changing your position. You 
may cause the heart to deviate from its usual lucus by turning from side to 
side. In deep inspiration the heart may descend somewhat, so that when you 
have taken a deep breath you may feel the beating of the heart over the pit of 
the stomach. That is, you can get the impulse at that place. 

As to the valves of the heart and their location externally: The aortic 
valves are located behind the third intercostal space close to the left border of 
the sternum; the pulmonary valves at the junction of the third costal cartilage 
with the sternum, on the left; the tricuspid valves are on a level with the car- 
tilage of the fourth rib just behind the middle of the sternum, and the mitral 
valves are at the third intercostal space, about an inch to the left of the ster- 
num. Since the valves are close together they are readily covered by the tip 
of the stethoscope, or what is better for our use, by the ear. And since they 
are covered by a small amount of lung tissue you can hear the heart better 
by having the patient hold the breath while you listen to the beating of the 
heart. For the resaon that these valves are so close together it is better in try- 
ing to distinguish the sound from each, to go out a little way in the direction 
of the current from the valve. Thus, in sounding the aorta valves, you would 
go to the second intercostal space, just at the right edge of the sternum. For 
sounding the pulmonary valves, you would go to the second intercostal space at 
the left edge of the sternum. To sound the tricuspids you would take the 
point at the end of the sternum just behind the middle, and to observe the 
sound of the mitral valves you would listen at the apex of the heart. That is 
according to the direction that the blood takes. 

For finding the outline of the lungs upon the chest wall: You know that 
the}^ rise above the clavicle an inch and a half, or in some cases two inches: 
that there is very little lung tissue behind the first part of the sternum; from 
the sternal articulation down to about the second rib, the anterior edges of the 
lungs converge. From the second to the fourth they are close togetner in the 
median line, quite close, also about parallel. Below this point their course on 
the different sides is different. On the right side it follows down along the 
course of the sixth costal cartilage. On the left it is notched for the heart, 
descending bacK: of the heart. On the left side it descends as far as the lower 
border of the fourth rib, which it follows. It reaches a line drawn perpendicti- 
larly from the nipple, at the lower edge of the sixth rib. In the axillary re- 
gion on each side it is found at the lower edge of the eighth rib, and behind, ex- 
tends as far down as the tenth rib. Of course in the deep inspiration it des- 
cends still lower. 

II. Examination of the Thorax. (Coutiutied.) — I began to take up 



124 EXAMINATION OF THE THORAX, 

this examination at the last meeting. I wish first to give you some points 
concerning the divisions of the thorax, which, while they are not of so much 
use to us as Osteopaths, as we do not divide the thorax into such spaces in our 
practical work, I thought it best to describe them to you for the sake of your 
understanding them when you come across them in your reading, so that you 
will know what is meant by the mammary region, the scalpular region, etc. 
This division is the one adopted by Loomis. He divides the chest first into- 
three general regions, the anterior, lateral and posterior. The area on the an- 
terior aspect is again divided: The supra-clavicular portion is that in general 
just above the clavicle. The clavicular portion is that corresponding to the 
inner three fifths of the clavicle, and is bounded by that bone. The infra-clav- 
icular space extends from the lower border of the third rib; internally it is 
bounded by the edge of the sternum, and externally by a perpendicular line 
dropped from the junction of the middle and outer third of the clavicle. Next 
below comes the mammary region, extending from the lower border of the 
third rib to the lower border of the sixth rib, extending inward as far as the 
edge of the sternum, and outward as far as the last described. Next, as for 
the sternal region: There is the suprasternal region, which he describes as the 
region just above the sternum. The superior sternal region is that portion be- 
hind as much of the sternum as lies above the inferior border of the third rib 
and the inferior sternal region, that behind the rest of the sternum. 

On the posterior aspect we have three regions: The supra-scapular and 
scapular, corresponding to the space from the second to the seventh ribs inclu- 
sive, and corresponding respectively to the supraspinatus and infraspinatus 
fossae of the scapula extending inward in this region as far as the inner or spi- 
nal edge of the scapula and extending outward as far as the axillary region. The 
infrascapular region extends from the lower angle of the scapula and the sev- 
enth dorsal vertebra down to the lower margin of the twelfth rib; extending 
internally in this Case to the spines of the vertebra and externally to the infer- 
ior axillary region, There is also an interscapular region, one on each side, 
corresponding to the space between the second and sixth ribs, and between the 
inner or spinal edge of the scapula and the spines of the dorsal vertebrae. 
Speaking, by the way, of listening to the sound of the aorta, it is also heard in 
the posterior region of the back from the third down to the ninth dorsal ver- 
tebra. 

Laterally we have the axillary space, bounded above by the axilla, and be- 
low by a line projected from the mammary space, that is, from the inferior 
border of the third rib. Then we have the infra- axillary space extending from 
the axillary space above down to the lower margin of the i2th rib; bounded in 
front by the infra-mammary region and posteriorly by the infra scapular region. 

You know already as far as practical for our work the contents of these 
different regions, especially when studied in conjunction with the points I have 
already given you in these landmarks. As I said, I give these general regions 
to you, not to detail the parts found in them, but so that y^ou will understand,. 



EXAMINATION OF THE THORAX. 1 25. 

when an author speaks of these general regions, what he is speaking of. You 
are of course aware that in making a physical diagnosis, of which our method 
largely consists, and which our medicalfriends seem to leave out in a great 
many instances, we use auscultation, inspection, percussion, palpitation and 
mensuration. In our examination we want to hear and see all that we can 
that is going on about the human body, especially in the way of examining and 
making out things which have caused a departure from the normal. I men- 
tioned certain points at the last lecture in relation to the chest. There is 
another point that I wish to speak of which is important in our practice, and, 
that is the movement of the chest' as to whether the two sides correspond, 
whether one side is restricted in movement as in the case of pneumonia or 
whether the inferior ribs are drawn in as in some cases of asthma, where I 
have seen them drawn in extensively. Also note whether or not the action of 
the opposite side is normal or increased to compensate for lack of normal on 
the other side. It is taken as a very good sign of tuberculosis if there is a 
depression in the infra-clavicular region. A great deal more might be said 
about these different methods of physical diagnosis, but it is hardly the place 
here to go into them extensively. In considering palpation, that is the ex- 
amination on the surface with the hand, I brought up certain points last time- 
We should not only touch both sides of the thorax in making the examination, 
but we should touch with equal force and touch in the same place each time, 
and you need not lay your hand on heavily, lightly is sufficient. Auscultation 
and percussion are by far the most important methods in dealing with the chest, 
especially since il contains the heart and lungs, and to get a good idea how the 
heart and lungs are behaving we must listen to them directly and also listen to 
them by percussing the region in which they lie. The authors, of course have 
different methods of bringing out these points. I have been reading Loomis 
and he seems to have some very good points. Of course they all make this 
statement, that percussion is either immediate or mediate. Immediate percus- 
sion or direct tapping upon the part is the old method and is very little used 
nowadays. The mediate style is the one used most, in which you use a little 
rubber tipped hammer ot some sort as you percuss, and what is known as a 
pleximeter placed between the hammer and the part sounded. This is very 
rarely used. It is stated by some authors that we have as good instruments as 
necessary, the middle or index finger of the left hand being the pleximeter and 
the fingers of the right hand being the hammer. There are certain simple 
rules that we may adopt in using this method of physical diagnosis. First, it 
will be of little value to you to find a difference in sound unless both sides of 
the chest or of the part of the body which is being examined are similarly dis- 
posed, so that one is not in a higher plane than the other. You must be ex- 
tremely careful of the position of the patient. Then, also, j^ou should have the 
parts slightly tensed. For instance, in examing the chest the arms should drop 
downward and the head be thrown back. If you are percussing the axillary 
region have the arms lifted. If you are percussing the back have the patient 



126 EXAMINATION OF THE THORAX. 

:Stoop over slightly so as to bring tension on the part percussed. That should 
be done evenly; a patient should not have one arm down and the other over the 
head. The condition on each side should be similar. It is well to make the 
examination directly upon the skin, or if that is not practicable make it upon 
some thin, soft cloth spread over the chest, of such a nature that it will not 
interfere with the sound. You should, of course, percuss equally on each side, 
and in case of the lungs you should take it at the same stage of respiration, 
that is, you should not tap on one side while the patient is inhaling and on the 
other side while the patient is exhaling You should have an equal pressure 
with the pleximeter finger and an equal forcibleness of the striking hand, 
t)ecause you can make the sound different by striking harder on one side or by 
by holding the hand more loosely against the surface you are examing The 
best percussing motion comes from the wrist and not from the whole arm, and 
in general tap lightly for an examination of the superficial parts and more 
forcible for parts more deeply located. 

In the practice of auscultation the same general rules will apply, you have 
the immediate in which you apply the ear directly to the part, or 5^ou have the 
mediate in which you use some instruement as a stethoscope. The authors 
differ a great deal as to whether a stethoscope should be used. Loomis is par- 
ticular that it should be used in examining the heart but does not care much for 
it in examining the lungs Rane, whom I sometimes read, says he prefers in 
all cases the use of the ear alone unless considerations of cleansiness make it 
convenient for the use of the stethoscope. If you are examing the chest and it is 
covered see that the covering is a thin soft cloth, a towel will usually do, some- 
thing that will not interfere with the sound. See that your patient is in a 
proper condition with both parts disposed alike, and give your full attention 
to the sound itself. The ear should be evenly applied in each case alike, not 
forcibly but firmly. You should listen to the corresponding parts and in 
touching you should touch over the corresponding parts, for instance it would 
not do to tap over a rib on one side and over the interspace on the other. You 
must examine the corresponding parts, no matter how you do it, and then, 
x)f course, especially in respiration, it is better to examine under condition as 
nearly normal as possible, have the patient breathing quietly and in a natural 
way. 

I mention these things to you more for the sake of a hint of what there is 
in the subject and what there is for you to study, since it is quite a complex 
subject to go in detail oyer the different sounds that you will hear, and to do 
so would probably confuse you more than elucidate the subject. Also it is 
very difficult to show these things Avithout clinic material, and you can onl}^ 
learn them by practice. You should become perfectly familiar with the sound 
of the normal parts both on auscultation and percussion, and then you will note 
-any departure from the normal when you come to make examinations, and 
also to distinguish the different abnormal sounds one from another. However, 
tiis is quite an important subject. I would advise you to become familiar with 



HOW TO EXAMINE FOR DISPLACED RIBS. 12 J 

the instruments that you are ^oing to use. I do not think it is generally 
recommended that the Osteopath should use a stethoscope. That is a matter of 
taste. The way is to get familiar with the sounds by the ear if you are going 
to use the ear, or familiar with a certain stethescope, as the sounds vary with 
different instruments. 

III. How TO Examine for DispIvACEd Ribs. I examined the different 
parts of the thorax at the last time. In the first place, I need hardly to remind 
you that in variations in the spine, any abnormal curve in the spine, either 
curvature or departure from the normal curves, will tend to alter the normal 
position of the ribs. So that in examining the spine if you find that the parts 
are not in normal position, of course you will at once look for dislocations in 
the ribs corresponding with the affected part in the spine, to see whether or 
not the affection has extended that far. You may find a general alternation in 
the shape of the chest, as for instance the flattening in the paralytic chest in 
its anter-posterior diameter; or flattening in lateral in rachitis, or bulging or 
barrel shaped chest in asthma or emphysema. Of course you will then see at 
once that there is a change not only in the thorax in general but in the parts 
necessarily, and that you will probably find that the ribs are misplaced. To 
examine and replace subluxated or displaced ribs is one of the most important 
parts of our practice, not only because it occurs so frequently, but because it is 
very troublesome. They often cause serious trouble and are hard to locate in 
some in.>,tances, they will require your very careful attention. We might ex- 
plain why it is that ribs when displaced cause so much trouble. I think the 
theory already advanced will explain that as far as it goes, that is, parts out of 
the normal, whether they be ribs or vertebrae, will bring pressure in some cases 
upon structures such as nerves and blood vessels; in other cases they would 
drag ligaments across important structures. In other cases they may result in 
contractures and that will be followed by other results already noted. So in 
examining a spine and the chest particularly you should examine each rib. I 
have already given you the rules lor counting the ribs, and having found 
where each rib is you should examine each rib in particular. It is said where 
a rib is displaced you will very likely find tender points along its course. Dr. 
McConnell says that usually there is a tender point at the spine where it is dis- 
placed, another about the middle region and another at the anterior end. You 
will also find cases where they are sore almost all the way along, especially the 
anterior half. 

The ribs may be pressed together behind and separated in front. In 
general you will look for the soreness over the rib and over the part of the 
interspace which is narrowed. I have found that to be so in my experience at 
least. The displaced rib may be separated from one rib, which naturally 
causes it to be approximated to some other rib, and you will judge which it is 
by finding the widening above and the narrowing below, for any one rib or any 
group of ribs. Then your rib may be changed, not being slipped up or down, 
but may be twisted so that you will find that edge is more prominent, and in 



128 EXAMINATION FOR DISPIvACED RIBS- 

this case it is very common to find the under edge the most prominent. The 
best method that I have found to examine whether the ribs are separated is to 
take the tips of the fingers and follow down the course of the intercostal spaces. 
You can then learn, knowing the normal, whether or not these parts are too 
much separated or too close together; you will also note whether or not they 
are not twisted. Sometimes the cartilages will be distorted, and in that case 
you will find an irregularity and a tenderness along them. Thej^ may be 
twisted or ma}^ have been torn and grown together. I have seen several cases 
in which the cartilage had been broken away from the tenth rib and the person 
liad three floaters on each side instead of two. It is said to be a fact that there 
is a little weaker attachment of the cartilages to the ends of the ribs in the case 
of the tenth than in the case of the other ribs. In examining the ribs of the 
patient what I have said will apply to all of the ribs, but of course we must 
apply our examination to all parts of the thorax, anterior and posterior. But 
in examining the first and second ribs you will find thai something more of a 
consideration. The first and second ribs, on account of their attachment to 
the scaleni muscles are usually displaced upward because the tendency of these 
muscles when contracted is to draw the ribs upward. In the first place, how 
would you tell whether or not this first rib is up? To find it you feel down 
about the middle point of the clavicle, press down and back and you will im- 
mediately come to the first rib. You must first know that the clavicle itself is 
in position. If its acromial and clavicular are both in situ then you can judge 
from the relative position of the first rib whether it is up or down. Of course 
the more it is slipped up, the more it tends to come on the level with the upper 
ridge of the clavicle, or if it is down it will widen the space between them. 
That is one of the best ways of determining by examination whether it be up 
or down. The second rib is somewhat more difficult to get at. You can feel 
it, as I noted, in the outer portion of this "infra clavicular space by drawing the 
arm outward and down, tensing the muscle. You can also examine it b}^ find- 
ing the junction of the first and second parts of the sternum; follow the car- 
tilage out, you can feel it as far as the clavicle. Note whether the points are 
sore at the places where you can reach the rib; and by following further there 
will be a difference in the intercostal space, and you can tell whether the second 
rib is up or down, but it wall require practice and I will promise you that the 
first and second ribs are very hard to deal with. Just as the first two ribs are 
usually up, the last two by some strange compensation of nature, go down. 
As the man said, "There is compensation in everything; snow comes down in 
winter and ice goes up in summer.'' The reason why these last tw^o ribs go 
down, especially the last one, is that the quadratus lumborum muscle is at- 
tached to it, and it seems to be the nature of the eleventh to follow the twelfth 
in its course downward, I do not know just why, unless it is because it is not 
attached by a cartilage to the others above, and is free to follow the other. 
The position of these ribs is very readily ascertained even in a fleshy person. 
It will take considerable dexterity of touch to accustom you to find them, but 



MANIPUI.ATION OF THE CLAVICLE. I 29 

by patience you can do it. Of course any of these ribs may not only be slip- 
ped up or down, but one may overlap the other. I saw a case the other day 
in which the tenth was overlapping the eleventh quite prominently. Then, 
3^ou may find that these last two floating ribs instead of being down may be up, 
and the twelfth my be pushed up under the eleventh. In that case they often 
cause trouble, but they may sometimes be down without any trouble at all, in 
which case it will not be necessary for you to bother with them. 

I wish to tell you how to set this clavicle. I noted it in the examination 
the last time. Suppose, in the first place, it is down. It may be down at 
either en-d. I believe the commonest place for it to be down is at the outer 
end. because of the attachment of the deltoid and of the pectoralis major to it 
at the outer end. The way the "Old Doctor" told me to treat that is to get 
the fingers against the anterior edge of the clavicle near the sternal end, draw 
the arm then inward, across the chest, thus relaxing the ligaments and the 
muscles. Then push outward upon the first point that I noted, the anterior 
edge of the clavicle, push outward, and draw the arm up backward. Thus 
having relaxed the ligaments and muscles, your push will serve, on account of 
the peculiar shape of the clavicle, to push it on to its proper articulation. In 
case it is slipped up at the acromial articulation, that sometimes happens and 
causes a catchhing of the fibers of the deltoid, or it impinges on the fibers of 
the brachial plexus, the best way is to raise the arm to relax all muscular ten- 
sion, since it is bound to the shoulder here by the deltoid party, and some of 
these smaller muscles; relax them in that way, and then you can get your 
fingers in behind the part that is slipped up, and it does not make much dif- 
ference which way you throw the arm. Dr. Harry says when a joint is out 
almost any way you turn it, it will want to pop back where it belongs, which 
of course is true, that is the tendency toward the normal. In case it is down 
at the sternal end, which you find with a fair degree of frequency, one of the 
best ways is to thrust the thumb of one hand under in behind the sternal end 
of the clavicle, thrust it in deeply, and then relax the muscles bj^ drawing the 
arm up and inward. Then by drawing the arm over, down and out and thus 
tensing the muscles, it brings a leverage upon that end of the clavicle, and will 
force it up. Or you do practically the same thing by bringing the arm up and 
around and making a twist in such a way as to tense the muscles In other 
words, this is just a system of animal mechanics whereby you study out the 
shape of the bones, their attachments and ligaments, and attachment of the 
muscles, and just how to use these ligaments, bones and muscles, as levers and 
pulleys, so as to work them back into place. Now, if the clavicle is up, the 
point of course would be to relax again and simply force it down from above 
by working with the thumb in behind it. Another good way to free up the 
space between the clavicle and the first rib is to thrust the fingers in behind 
the clavicle where it is always tender, and draw the arm up over the face and 
then on out, thus getting a very good leverage. 



130 NERVE CONNECTIONS OF THE HEART, 

LECTURE XXI. 

At the last lecture I took up certain landmarks of the thorax, showin g: 
you, among other things, what was the outline upon the chest wall of the 
heart, where to note its valves, and where to listen to the sounds produced by 
their action; that the point at which you should listen, varies from the position: 
of the valve in the direction of the current of blood. Also I noted the topo- 
graphy of the lung upon the chest wall. Then I took up certain points in the 
examination of the thorax, showing you how it was divided into the different 
regions; then spoke concerning auscultation, palpitation, mensuration, percus- 
sion, etc., the different methods that we use. Then I brought up the point of 
how to examine for displaced ribs. To-day I wish to take up more particular- 
ly the contents of the thorax, viz., the heart and lungs. They are, of course, 
important to the Osteopath, and since they have so much to do with life, they 
must be carefully looked after. I think that the Osteopath has more success 
than other forms of healing with troubles in the heart and lungs. A great 
many troubles of the heart are not organic, and when not organic the oppor- 
tunities for Osteopathic work are much better than when organic. 

I. Some Centers and Nerve Connections for the Heart and- 
Lungs: There are certain facts that we come across in our Osteopathic work 
^vhich lead us to reason about nerve action. In the first place, displaced ribs 
will very readily affect the heart. Sympathetic troubles, such as crying and 
the like, are caused by contractures along the left side of the back between the 
shoulders, or by displacements in that region; displacements of the third, 
fourth and fifth ribs particularly. From the fact that we can reach the heart 
through the superior cervical ganglion and in the upper dorsal legion on the 
left side, and from the fact that there are certain centers given, as that in the 
medulla, and for the rhythm of the heart in the upper dorsal region, from the 
second to the fourth, we naturally wish to know what is the nerve connection, 
and why it is that working there we can get such an important effect upon the 
heart. That we do get these effects, of course our practice shows, it is simply 
a question of fitting theories to these facts. In the first place, we sometimes 
work along the splanchnics, and thus get an effect upon the centers, which I 
explained at length in the lecture the other day. Then there is our work in 
the upper dorsal region. Those are the two places, except the neck, where we 
get the most important effects. Now, as to this nerve connection between the 
heart and the spine, Jacobson brings out the connection here very admirably, 
in relation to infra-mammary pains. He shows how the viscera are connected 
through the sympathetics, the great splanchnic particularly, connected with 
the spine as high as the fourth, fifth and sixth spinal nerves. We have learned 
that the great splanchnic may arise as high as the third also. These spinal 
nerves send certain sympathetic branches to the aorta, from the fourth, fifth, 
and sixth sympathetic ganglia branches are given off which form a plexus- 
about the aorta. This plexus over the aorta gives branches to the cardiac 
plexus about the heart. Further, there are branches given off from the fourth,. 



NKRVK CONNECTIONS OF THE LUNGS- 131 

fifth and sixth, cutaneous branches, descending over the ribs and supplying 
parts along the sixth, seventh and eighth ribs. Hence you have a direct con- 
nection between the pain which you feel by means of these cutaneous nerves 
of the sixth, seventh and eighth interspace which run in their distribution be- 
neath the breast, in the infra-mammary region, a connection with the spinal 
nerves and thus with the fourth, fifth and sixth spinal nerves, and through 
them out to the sympathetic plexuses about the aorta and the heart. Thus, 
you have an indirect connection between the viscera on the one hand, and the 
heart's action on the other. You may have pains in the infra-mammary re- 
gion caused by diseases of the heart. Hilton, himself, also states something 
concerning the sympathetic pains which we may feel on the surface of the 
body. That pains from diseased viscera, the liver or intestines, for instance, 
are often reflected to the region between the shoulders or at the inferior angles 
of the scapula. You can readily see how this connection takes place, between 
the sympathetics from the great splanchnics and those of these fourth, fifth 
and sixth, and directed to the region of the scapulae and the region between 
them and about their angles. Thus we see how we may have pain in a distant 
part of the body when a certain terminal is affected. I have, myself, noticed 
in certain cases of trouble with the liver, where the liver was rather ten der, 
that I could get a pain under the scapula, especially on the left side. 

Taking into consideration the connection between the heart and this upper 
dorsal region, the fourth, fifth and sixth, you can see how the Osteopath, by 
working there, where he does very frequently to affect the heart, can get an 
effect upon the heart, and thus upon the general circulation. I think I instance 
the point that by working along the splanchnics and by working along the 
upper dorsal region, I could get important effects in quieting the heart. I have 
sometimes quieted the heart as much as from ten to twenty beats per minute, 
when it was running high by work iu this region. Thus you will see that 
work here upon the heart is directly upon nerve action, but we must not omit 
to notice the fact that by raising the ribs we get a mechanical effect, if those 
ribs were so lowered as to narrow the cavity in which the heart acts. Any 
lessening of that cavity has a tendency to interfere with the heart's beat, so that 
by mechanically enlarging the cavity we also get an effects upon the heart. It 
is probable also that the raising of the ribs frees pressure upon nerve connec- 
tions along the spine. 

Further, as to connections in the upper dorsal region between the nerves 
there and the heart, Quain says, that accellerator fibres of the heart derived 
from *he upper four or five dorsal nerves but chiefly from the second and third, 
are sometimes found. The spinal fibres end and sympathetic fibres begin iu 
the middle and lower cervical, perhaps also from the first thoracic ganglion. 
That is, these fibres really come from the vSympathetics, the change of 
fibres occuring in the ganglion mentioned. 

He says further, ttat vaso-constrictor fibres of pulmonary vessels have 
been found in the dog from the second to the seventh spinal nerves, and they 



132 E^XAMINATIOTT OF TllJj HKART. 

conneet in the stellate ganglion. In the dog and the cat it is said thai the low- 
er cervical and upper thoracic ganglia are connected to form what is called the 
stellate ganglion. While it has not been demonstrated in man that these fibres 
arise from the second to the seventh, these vaso-constrictors for the pulmonary 
vessels, it looks probable that there are some such fibres existing, since that is 
the identical center upon which we w^ork to affect the lungs, the second to the 
seventh dorsal. Howell's Text Book states that stimulation of the vagus in 
the neck constricts the pulmonary vessels, while stimulation of the sympathet- 
ics of the neck will dilate the pulmonary vessels; also that there is noted a re- 
flex contraction of the pulmonary vessels by stimulation of some other nerve, 
as "for instance, the sciatic, intercostal nerves, abdominal pneumogastric, or ab- 
dominal sympathetif^s. This will call to your mind instantly what I have said 
concerning regulative processes, in our work upon different parts of the bod3\ 
I mentioned that particularly in relation to the splanchnics; you see the reflex 
effect gained by stimulation of these nerves in different parts of the body and 
its effect upon the lungs. You see how general that work may become. 

It is an interesting fact to note what Robinson says concerning the heart 
and the aorta, which are directly connected with the circulator}^ system. He 
says that they have been noted at times to have periods of violent, rapid beat- 
ing, and that the heart itself and the aorta appears to be dilated and to be work- 
ing very forcibly; that feeling of the pulse in other parts of the body would not 
indicate that the effect was general. Robinson says that this has been little 
made of in books, in fact, he does not know that it is mentioned except some- 
thing abuut the aorta, and explains it b}- influence of one kind or another 
which may affect the various local sympaihetic centers. And in case of the 
aorta he says he has seen, in case of a thin woman, it beating violently and 
simulating in every respect an aneurism. He explains it by saying that the 
centers in the substance or in the immediate neighborhood of the aorta, are in 
some way affected, though the effect may, of course, be dependent upon general 
corditions. 

II. KxAMixATiON OF THE Heart. — First, some general points as to the 
heart. The ''Old Doctor" explains some of his recent illness by a stoppage of 
the aorta at the point where it perforates the diaphragm. He sa^'s that fre- 
quently some injury there may cause a constriction, especially if the injury is 
of such a kind as to allow a relaxation of the usual vault of the diaphragm, 
causing a constriction about the point where the aorta passes through, and 
thus constricting and restricting the blood flow. Thus, he says, the heart goes 
to work pounding to force the blood through, and you have palpitation of the 
heart. That is similar to effects we have in other parts of the body, where a 
thickening of parts about an important structure would lead to troubles which 
were of peculiar significance to the Osteopath. So the "Old Doctor" wears a 
belt. He says that compresses the lower part of the thorax, allows the aorta 
to bulge upward. 

Second, as to your examination. You must take into consideration that 



B:^AMrkAf ION OF THK HKART. 1 33 

the heart, being so closely connected with sympathetic life in every part of the 
body, is affected by general sympathetic disturbances. You may have trouble 
almost anywhere, in the neck or with the genital organs; and of course you 
get an important effect upon the heart and circulation by dilation of the rectal 
sphincters. Such a slight cause as a dropping of the acromial end of the 
clavicle, or either end of the clavicle, for that matter, shutting down upon the 
circulation through the subclavian artery and vein, generally the vein, has 
caused angina pectoris. I knew of a very bad case where the woman was 
ready to die of heart trouble and looked about as bad as a person could look. 
She was cured by the "Old Doctor" by setting the clavicle. It was a typical 
case, with the radiating pains over the chest and all the accompanying symp- 
toms. That lady is one of our graduates now and enjoying a lucrative practice. 
Also the same kind of a slip may cause a periodic emptying of the innominate 
vein, and thus lead to a loss of a beat of the heart occasionally, so that the 
heart will be beating irregularly. So please consider that in looking for trouble 
with the heart, you will need to examine not only the region of the thorax, 
but everything that might affect the vessels coming from it. Do not forget 
the clavicle or the first and second ribs are apt to cause troubles of the heart. 
The reason seems to be that since they are usually displaced upward, they 
bring pressure upon some of the blood vessels or interfere at che spine with 
some of the important nerves which I mentioned in the previous part of my 
lecture. I do not know but that it should be as much a matter of pride with 
ns to observe a professional demeaner in our calling upon a patient, as it is with 
our medical friends. I have gone with a student to see a patient where there 
was trouble with the heart — I remember one case particularly, a case of asth- 
ma. I went in and felt the pulse the first thing, as I usually do; the heart 
was beating at the rate of 120 per minute, and the student had not noticed it. 
It will not be a bad idea to always note the pulse. It is, of course, an import- 
ant clue to the state of the circulation. It will tell you whether or not the 
heart is intermitting, whether or not the heart is beating too strongly or too 
weakly; whether or not the pulse is normal in every respect. The strength 
of the beat you can tell, then, and the frequency and the regularity So I 
first take the pulse, which is usually found best at the left wrist at the radial 
artery; you all know how to find it. Also note the chest, the shape of it. In 
enlargement of the heart there may be a bulging in the precardial region. 
Or narrowing of the chest may interfere with the heart. Do not forget in- 
spection of the chest in examination for troubles of the heart. Note also 
by inspection and by palpation whether the apex beat is normal, occurring 
at the interspace between the fifth and sixth ribs. Vou can, by knowing- 
how it beats normally, tell when it has departed from the normal, whether 
it beat too strongh^ or weakly. Or it ma)- be displaced to one side or the 
other by troubles of the other viscera, the lungs, for instance. Notice by 
inspection and palpation where the apex beat occurs. B\' palpation, not 
only at the apex but over the region of the heart, preferably with the pa- 



134 EXAMINATION OF THE LUNGS. 

tient sitting up, you can note the three points that you want, that is, regu- 
larity, frequency and strength of beat. It is not a bad point in examining 
for enlargement or encroachment of other solid viscera upon th e heart, to 
use percussion. It is as well to percuss next to the skin, or through some 
soft thin cloth. Tne best way to make a pleximeter of your left hand is by 
laying not the whole palm of your hand, but just the middle finger upon the 
surface to be percussed, and then striking it with the tips of the fingers of 
the right hand brought in line, or by the first or index finger. Of course 
when you come to the heart you note its flat sound. I noted to you the 
other day how to find that region, a circle drawn two inches about a point 
midway between the nipple and the end of the sternum. 

Dr. Sheehan called my attention to a point the other day: In making 
the percussion over the parts of the lungs which are most liable to be affect- 
ed in tuberculosis, make it light, because there is some danger of starting a 
fresh hemorrhage if you use forcible percussion. Light percussion is as ef- 
fective as is forcible. Of course this flat sound of the heart may vary, as for 
instance in emphysema it may become resonant. Or it may be increased by 
some effusion in the pericardium, or some effusion in the pleura or some 
enlargement of the stomach upward, or by solidification of the lung, any- 
thing that will make a larger area of the flat sound in the region of the 
region of the heart. By studying these things they will be an important aid 
to your diagnosis. 

We also practice auscultation upon the heart, by placing the ear over the 
region of the heart. This is the best method of examining the heart. You 
will want to note the sounds of the heart particularly, and for doing that 
you would have to know the sounds for the various valves of the heart. Of 
course there are various murmurs, regurgitant, restrictive, etc. There are 
murmurs tha'c occur in several conditions of the heart. Sometimes there is 
a \'enous murmur, as in the jugular vein. It is said that by holding that vein, 
and compressing it for a few minutes you can stop that hum. To differen- 
tiate between it and the heart murmur, particularly that caused by friction of 
the heart against the percardium when it has been thickened by some in- 
flammatory process, is difficult. It is also dif^cult to differentiate from other 
murmurs in the heart, and the only way is to find that this sound follows, 
while the other accompanies the heart beat, 

A great deal, I am aware, might be said about physical examination of 
the heart, about the analysis of these sounds, but should I go into that sub- 
ject extensively it would make a set of lectures as large as that I am deliver 
ing in general. It is only by study along those lines and by practice that 
you will learn both the normal and abnormal. But I brought them up for 
your notice, and leave them for the more important part, the Osteopathic 
practice, which I shall consider here. 

III. Examination of the Lungs: — We adopt the same methods for 
percussing the different regions of the chest. For instance, if you were 



TREATMENT TO RAISE THE RIBS. 135 

sounding here over the clavicle, you get a dull sound; while in the space 
below we should get a resonant sound; over the larnyx, especially with the 
mouth open, you get a higher sound called tympanitic. You must become 
accustomed to these normal sounds. Anything which will cause a solidifi- 
cation of the lungs about the tubes or thickening of the tubes themselves, 
in fact, an accumulation, or any growth which aids transmission of sounds 
will change the character of these sounds, making them more resonant, 
higher; while the effusion of any liquid, such as blood in hemorrhage, or in 
the case of pleurisy the effusion of lymph or serum, or the accumulation of 
pus will also interfere with the sound and make it more dull. There is a 
tympanitic sound found in the lung when there is a large cavity not com- 
municating with a brochus; when the cavity communicates with a bronchus 
we get whal is called the "cracked-pot sound." Our chief methods of ex- 
amining the lungs are by percussion and auscultation; these are two of the 
best methods. I am aware that this subject under my treatment is a very 
dull subject to you. However, it will be a very important one and will mer- 
it further study. If I had time and ability to go into the subject more fully 
I would spend more time upon it. As it is I can best call your attention to 
the more important Osteopathic points in relation to the lungs by taking 
up certain of the troubles which affect the lung. As for instance in asthma 
you may have trouble anywhere along the back from the second to the sev- 
enth ribs, especially on the right side. It is said that the sixth rib upon 
either sids may be displaced and cause this trouble, or if there is any pain 
upon taking a deep breath probably the fifth rib is interfered with. There 
also may be an interference with the phrenic and pneumogastric nerves in 
the neck, some stoppage of the nerve force in those nerves will cause asth- 
ma. In case of bronchitis it is said the first, second and third ribs are at 
fault, especially the first, or the clavicle may be displaced downward, or 
either of the nerves I have mentioned in the neck may be impinged upon. 
In congested lungs you will find the best method is to work along the upper 
dorsal region, raising all the ribs. I have at that point ver\' quickh' relieved 
the congestion in f he lungs, simply raising all the upper ribs; working be- 
tween the shoulders. 

Hay fever is usually found in lesions from the third cervical down to 
the fifth dorsal; you may liave trouble either in the neck or of the upper 
ribs, or your clavicle may be displaced, or those nerves I ha\'e mentioned 
may be impinged upon. Of course in working upon an\- of these troubles 
where there is probability of complication with general troubles you must 
take that into consideration; In relation to the lungs. Dr. Still has been 
speaking recently of the formation of gases upon the lungs, and that in fever 
the gases are formed but are not transformed into perspiration, and there- 
fore the natural cooling process does not go on and\ou have feser resulting. 
In fever his work is largel}' upon the lungs, he says, to stimulate them lo 
action to cause the proper combination of gases and the resulting perspira- 



136 TRKATMKNT TO RAISK THK RIBS. 

tion. In. the same way he explained the other night the cause of the abnor- 
mal amount of secretion of sweat in cases of cnolera. 

As to how to raise the ribs: I brought out the points of examination for 
the ribs the last time. Dr. Charlie Still has the patient take a deep breath, and 
then by placing the fingers of one hand upon the spinal end of the rib, and of 
the other on the sternal end of the rib, he pushes the rib either up or down. 
That is one method which he uses. Dr. McConnell frequently works with his 
knee in the back, as do also the other operators, and in that case the idea is to 
get the point of the knee at the angle of the rib which is displaced, and then 
you can have one hand free to reach over the shoulder of the patient and get at 
the sternal end of the rib, while with the other hand you bring the arm up, 
thus tensing the pectoral muscles and the latissimus dorsi, which are attached 
to the ribs; drawing the arm toward the head, back and around in such a way 
as to draw the ribs up. When you have gotten them up to their highest point, 
then relax the arm and let it drop, still holding the knee and the hand against 
the ends of the rib. Dr. McConnell, also sometimes works by getting the knee 
against the back and by putting both hands against the front part of the rib, 
especially when you want to raise the front part. It does not make very much 
difference, anyway you can get tension of the pectoral muscles and the latissi- 
mus dorsi. getting a leverage on the ribs, and having a fixed point against the 
ribs behind; no matter how you do that you will be able to move the rib. 
There is another way which is frequently used, and that is, the patient being 
upon the table upon his side, you can place the knee in the back in the same 
way, you can place one hand upon the arm of the patient, the other upon the 
anterior end of the rib and draw the arm up and back in the same way; thus 
5^ou can raise any one or all of the ribs. Also, as I showed you the other day 
in treatment of the liver, you can reach across and beneath the patient, getting 
your fingers against the angles of the ribs and using the tension of the pectoral 
muscles in the same way to draw the ribs up. You will find all of those methods 
quite simple, and the reason, perhaps, that there are so many different ways 
devised to raise the ribs is the fact that you have to work in so many dif- 
ferent positions, sometimes one will be more convenient, sometimes the other. 
This will serve to raise the different ribs. But when you come to the first and 
second ribs it is a different matter. These displacements are usually upward 
owing to the scaleni muscles being attached to them. Hence to treat them, we 
make use of these muscles. When these ribs are up, one good way is to bring 
the head of the patient toward the side of the rib affected, then pressing the 
fingers down behind the middle of the clavicle, in that way you come to the 
first rib. You can get firm pressure there and can bring tension upon it by 
pushing the head in the opposite direction, thus stretching the scaleni muscles 
which are on a strain and which, are holding the rib up. Thus we get those 
muscles stretched and by working the head around and bringing pressure still 
upon the first rib, you can press it downward. That applies to both the first 
and second ribs. Of qourse, also, in case of the second rib you can get the 



TREATMENT TO RAISE THE RIBS. J 37 

pressure against the angle behind and raise it by working in the back, drawing 
up with the pectoral muscles as before shown. 

Dr. Harry Still frequently works as follows upon the upper ribs; 
in this way you can get your hands upon the first two ribs. He puts one hand 
beneath the angle of the rib and with the other he grasps the elbow of the pa- 
tient and presses the arm down across the chest, thus springing the ribs out 
and up, and can get quite a leverage in that way. This is very good for 
these upper ribs. In case of overlapping or twisting of the ribs the same 
motions that I have already shown you for raising or lowering the ribs will 
apply. In case you wish to treat the cartilages alone, which you must not 
omit in your examination, it is well to work with the fingers against the 
cartilages in front, drawing the arm up about the level of the shoulder and 
pushing if backward, you thus raise the ribs and free the cartilages, and you 
can work and twist out of them in that way, or work them up or down at the 
time. I have heard that method mentioned by Dr. McConnell. 

As to the lower ribs they may be up or down, or slipped or twisted in 
different ways. One of the best methods is to flex both knees, then, by get- 
ting your thumb against the point of the rib which is out, you can bring 
pressure there, with the fingers of the same hand back of the angle of the 
rib, then by drawing the legs dqwn in this way you can get a stretching mo- 
tion upon the muscles. In case the displacement has been downward by con- 
traction of the muscles, you will hold the rib up in that way and thus stretch 
the muscles. Or in case the rib has been displaced upward you must work 
it down as you go by tension of the muscle in straightening of the knees, 
and by pressure with the thumb. Dr. McConnell has the patient take a deep 
breath, he then, in case the rib is displaced downward, exaggerates it b}' 
pressing it still further downward at the free end and upward at the spinal 
end, and then when the patient lets the breath go he will simply work the 
part up; he thus springs the part, gets a fulcrum by having the lung inflated 
and allows the rib to take its natural position. You cannot always set a 
rib at the first motion. It will sometimes take considerable attention and 
considerable length of treatment to effect your object. There is also one 
more method which I saw Dr. Charlie Still use the other day for raising the 
floating ribs, or any of the other ribs. This is what you would call a quar- 
ter turn. He gets his arm under the legs of the patient and brings him 
around until he is a quarter turned off of the table, then he swings the pa- 
tient downward, upward, and backward, meanwhile he has kept his fingers 
against the angles of the ribs, and thus by pressure of the hand worked them 
back into place. 

Q. Demonstrate to us the method of giving immediate relief in sexere 
cases of asthma. 

A. Any of the methods that I showed \ou of raising these particular 
ribs on the right side. 

O. In the case of the eleventh or twelth ribs being pressed right into 
the liver, would the motion you gave us bring it out? 



138 THE LYMPHATICS. 

A. Yes sir, by relaxing the unnatural tension, no matter which way the 
the parts are. These motions were given to either raise or lower the ribs- 
In the first place, the motion of extending the limbs will, by the tension 
brought upon the quadratus lumborum, draw the limb down. You also, o^ 
course, push under with your thumb, and get it against the point of the rib 
and work it outward as you go. 

Q. If one lung is badly diseased would it affect the pulse on that side? 

A. Not particularly on that side, it would probably affect the pulse in 
general, probably make it weaker. 



LECTURE XXII. 

At the last lecture I considered the heart and lungs, taking up first 
some nerve centers for the heart and lungs, showing that the theory of our 
work was, first, that we work along the splanchnics, getting a general equal- 
ization of the circulation, general effect upon the heart and lungs, and fur- 
ther that we especially work in the upper dorsal region f©r this effect. I 
also showed you the relation between intercostal and inframammary pains 
— pains coming from the 6th, 7th, and 8th cutaneous nerves referred back 
to the 4th, 5th and 6th intercostal nerves, these connecting with the plexus 
about the aorta, and also in that way with the heart; also that in the same 
way a connection could be traced from the viscera to the spinal nerves, es- 
pecially the 4th, 5th and 6th; and explained the visceral pains referred to 
the surface of the body about the shoulders and between the scapulae. Then 
I mentioned certain accelerator fibers for the heart and lungs, and took up 
the examination of the heart and lungs but had not time to go into the 
treatment of the heart and lungs. I also showed you the different 
methods of raising the ribs. Today, in the latter part of my lecture I wish 
to consider the general treatment of the heart and lungs. 

Having previously taken up the spine, head, its parts, and the thorax, 
we have now come to the abdomen, which I wish to consider today. First, 
however, some general points concerning the lymphatics. Occasionally 
the question arises in an Osteopath's mind, what is his duty in reference to 
the lymphatics? What can he do with them? Since they are important in 
the nutrition of the body, how can he gain control of them? Of course, 
since they have to do with nutrition, they are affected by general conditions 
of the body. Anything which affects the general nutrition of the body will 
affect the lymphatics, and \'ice versa. You find glands along the lymphat- 
ics, conglobate glands, as they are called, especially in the neck, although 
every part of the body is supplied with them. I have mentioned the fact 
that the l}'mphatics are scavengers, and that if }'Ou note any enlargement 
in the neck, it shows some trouble in the head. I have one case particularly 
in mind, a case of measles followed by a serious trouble of the eyes, where 
these glands were enlarged, and had been so for quite awhile. Another case 



CONTROL OF THE LYMPHATICS. I 39 

of measles with whooping cous^h had been followed by enlargement of the 
glands. Another case I noted where an operation had been performed near 
the knee for abcess, it was on a cadaver that I saw it, the femoral glands at 
the groin were still enlarged, that being the set of glands in the course of 
the lymphatics which drained the lymph from the limb. Of course in ton- 
silitis, or septic processes, these glands are affected. It is well that is so, 
for they prevent the passage into the blood of this septic matter, which 
would, of course result in blood poisoning. In such cases I have called to 
your mind that you must not treat directly over the gland, but indirectly, 
to remove the original cause. 

As to the direct treatment thai we get upon the lymphatics, you often 
find that the clavicle is down, and in such case it may stop up the opening 
of the thoracic duct into the subclavian vein, so occasionally we have to 
look to see whether or not the clavicle is lowered. The first rib may cause 
the same trouble by being raised. A tightening of the tissues in these parts 
may cause a stoppage of the thoracic duct or of the right lymphatic duct. 
Little is known concerning the innervation of the lymphatic system. It is 
known that the lymphatic vessels are supplied in their middle and inner 
coats with involuntary muscular fibers. The physiologists tell us that the 
flow is influenced in three main ways: First, the general muscular exercise 
of the body, aided by the action of the valves in the lymphatics which pre- 
vent a backward setting of the lymph, helps forward the flow. Another 
method by which its flow is aided is the movement of the thorax in inspi- 
ration and expiration; the pumping motion of the chest. The third way is 
the vis a tergo, the force of the circulation behind — the continual expul- 
sion of the lymph from the blood vessels forcing the onward flow of the 
lymph in the lymphatic s}'stem. Of course the flow is more restricted b}' 
the presence of the glands in the course of the lymphatics. However, it is 
stated that there are certain nerves controlling all these lymphatics. That 
there are fibers in the upper cervical region which control the calibre of the 
duct. That probably the thoracic duct itself, and the general lymphatic 
system are under the control of the sympathetic system. And the recep- 
taculum chyli is probably under control of the splanchnics directly. There 
is a point at the fourth dorsal called by the '"Old Doctor" the center for nu- 
trition. He works there in cases of obesity, as well as in the upper cerxical 
region. In cases of obesity also there is frequently an enlarged cushion, you 
might call it, of flesh in the upper dorsal region; you will find that in all 
most every case where a person is extremely fleshy. It is said that the en- 
largement affects not onh' the general condition of the body in that way, 
but the heart and the eyes as well, and I have frequently seen it so. Mrs. 
Patterson, in describing the treatment of obesit}', said that we treat in this 
region to reduce that cushion of flesh; work also at the 4th dorsal and in 
the upper cervical region, working along the transverse processes, alter- 
nately stimulating and inhibiting nerve force, and thus getting an effect 



140 NERVE CENTERS AND CONNECTIONS OF THE ABDOMINAL CONTENTS. 

Upon the thorcic duct. So that the Osteopath sometimes works directly to 
remove some obstruction, as for instance, at the clavicle or the first rib, and 
then the effect that he may get through its possible nerve supply, added 
also to the effect that he gets by general manipulation of the body and the 
stimulation of the lungs and the working of the parts, which would aid all 
the onward flow, And where the trouble with the lymphatic system is due 
to the general condition of nutrition, there he would get his indirect effect 
by working upon the lungs, heart, bowels, liver, kidneys, and all the excre- 
tory and nutritional organs. 

As to the abdomen, we know that it is important to us from the fact 
that its contents are so often complicated with disease. It contains import- 
ant organs of nutrition. These organs are directly accessible to pressure 
from the outside, hence it is the Osteopath works so frequently upon the 
abdomen. Here I belie\'e, too, we are in danger of becoming masseurs — 
simply to knead the abdomen, as you might say, which of course is not the 
principle at all, although we work upon the abdomen and frequently knead 
it. The principle is to work for the blood and nerve control, as in other 
cases; occasionally we do use a kneading to force onward the fecal matter 
in the large intestine. 

The abdomen is important, then, since it is related to the general 
health, and is readily reached by us. The fact, also, that we reach it through 
the splanchnic nerves along the spine, of which I have already spoken, and 
through the solar plexus in front, which we can get b)' deep pressure, makes 
it an important part to us. When we work upon these ner\-ous connections 
we have influenced the various viscera, since the\' are all connected. 

II. Some nerve centers and ner\'e connections of the abdominal contents. 
The general facts in this connection have already been considered. I 
have mentioned the effect of abdominal tumors — the fact that a tumor 
pressing upon the s)'mpathetics may produce an effect in distant parts of 
the body. I call your attention again to the familiar splanchnics; yon know 
where to reach them; nervous influence passes from them to the sola? 
plexus, the solar plexus is intimately connected with the other prevertebral 
plexuses, viz., the hypogastric and the pelvic plexuses, and these in turn are 
connected with the secondary plexuses — the diaphragmatic, the superior 
and the inferior mesenteric, the renal, the coeliac, prostatic, vesicle and 
uterine, and all the secondary plexuses. So it is not strange that, as I 
stated, there will hardly an hour pass in your practice that you will not 
work upon the splanchnics for something or other. Do not fall into the er- 
ror of thinking that it is only by our work upon the splanchnics and the so- 
lar plexus that we reach the abdominal organs. Because, as you know, this 
chain of sympathetic ganglia extend the full length of the cord; there are 
four lumbar and four sacral ganglia, and branches from the lumbar cord 
pass to these plexuses of the sympathetic and have to do with the life of 
the viscera. Sornetimes reflected jmpuls;.es are sent, as for instance, abdo- 



NERVE CENTERS AND CONNECTIONS F,OR THE ABDOMINAL CONTENTS. I4I 

minal tnmor causing hypertrophy first, and then degeneration of the heart. 

However, to take a slightly different course, I wish to call your atten- 
tion to the explanation given for a frequently observed phenomenon, that 
is, in hysteria, frequently a pain is felt in the hip or knee, a cramping of 
the leg or pain on the inside of the knee. The explanation given by Hil- 
ton is as follows; that from the ovaries and uterus, which are supplied by 
sympathetics, branches run back to the sacral sympathetic ganglia, thence 
branches run to connect these organs and these nerves with the great sci- 
atic and with the obturator nerve, also with the sacral plexus of nerves. 
Now, the great sciatic, as you know, supplies the thigh, or at least sends 
branches to the hip joint, and the obturator also has articular branches to 
the knee joint. Hence, it is not strange that uterine irritation will produce 
a pain along the paths of these nerves and may affect the hip or knee-joint 
or both, or the inner side of the knee. The same thing is noted in intestinal 
.diseases, where the irritation in the lower bowel may send the same kind 
of an irritation over the same nervous connections and on down the leg, 
and you have a sciatica caused by trouble in the bowel. Cases have been 
noted frequently in our practice, where a pregnant uterus or the pressure of 
a large amount of fecal matter will cause a cramping of the leg; a twisted 
ilium would have the same effect. These nerve connections are all ex- 
tremely interesting to us. However, we should not lose sight of the main 
points in our work upon nerve connections; when we are considering nerve 
connections we are apt to become too theoretical. If we can trace the 
pain up the leg to the sacral plexus and find a twisted ilium, we have done 
the work which is almost peculiar to the Osteopath. And so it is that we 
must look for the original cause whatever it may be. And remember, please 
that it is very frequently that the Osteopath finds a displacement of parts, 
and the successes of our practice have been largely because we understood 
where to look for and how to adjust misplaced parts. 

In the first few lectures I gave you certain centers which had to do 
with the viscera, for instance, the second lumbar, being the center for par- 
turition, defecation and micturition. But there are other nerve fibers supply- 
ing these parts which I wish to call to your attention. I noted the fact that 
th,e "Old Doctor" calls the nutrition center in general from the 6th dorsal 
down, and so you will see that it has to do with visceral life, and hence with 
the nutrition of the body very largely. Ouain, in speaking of the lumbar 
portion of the sympathetics, says that spiral fibers decend in the cord from 
the lower dorsal region, and that fibers also pass from the first one or two 
lumbar nerves to the plexuses of the sympathetics, and that the\' carry \'aso- 
constrictor and secretory fibers to the lower limbs. These have been dem- 
onstrated more particularly in animals, but there is not much doubt but 
that they exist iu man; also vaso-constrictor fibers to the abdominal vessels 
are found in these nerves; and motor fibers to the circular, and inhibitory 
fibers to the longitudinal muscles of the rectum. From the lumbar nerves- 



142 LANDMARKS FOR THE ABDOMEN. 

we get, first, motor fibers to the bladder, they pass down to the hypogastric 
plexus on the pelvic plexus and are then distributed to the bladder. They 
supply the circular muscles, including the sphincter of the bladder, and 
probably also some inhibitory fibers to the longitudinal fibers of the blad- 
der. In the next place, we get motor fibers to the uterus, which follow the 
same course as the motor fibers to the bladder. It is a fact that there are 
no spinal nerves from the sacral region running to the ganglia of the sym- 
pathetic. The spinal fibers which run to the sympathetic ganglia in this 
region come from the lumbar cord or from the lumbar nerves, and it is 
through the spinal branches of the sacral nerves that we get the effect 
that we do by our Osteopathic work in the sacral region. Plence, the im- 
portance of all the work the Osteopath does upon this region 
for the pelvic viscera. Frequently you work along the lumbar region 
to get an effect upon the organs contained in the pelvis, and it 
is on account of the sympathetic connections here rather than 
with the sacral cord, that we work here, However, we work also down 
lower, but where we work in the sacral region we get an effect upon spinal 
nerves. The fourth sacral nerve, spinal, having branches from the second 
and third, and sending branches to the fifth, is called bv Gaskell one of the 
pelvic splanchnics, as it has visceral branches. Having connection with 
these upper sacral nerves it runs out to form a plexus with the sympathet- 
ics, and goes to the bladder and other pelvic viscera. And we frequently 
work over the sacral region to release tension there, set the coccyx, or set 
a slip in the innominate, or remove anything which may affect nerve force 
there. From these visceral branches of the sacral nerves we get the fol- 
lowing: First, motor fibers to the longitudinal and inhibitory fibers to the 
circular muscles of the rectum; second, motor fibers to the bladder, prob- 
ably chiefly to the longitudinal muscles. Third, motor fibers to the uterus; 
fourth, secretory fibers to the prostate gland. So here we have a rather 
anom.alous condition of working directly upon the spinal nerves to get a 
direct effect upon the viscera. You will find that from the sacral fibers, 
through the spinal nerves, we get certain fibers to the bladder and rectum, 
Avhich are contrary in their action to the fibers to the bladder and rectum 
derived from the lower lumbar region, for instance, the fibers to the longi- 
tudinal muscles of the bladder are motor, while those to the circular muscles 
of the bladder are inhibitory in the case of the sacral nerves. In case of 
the lumbar, they are just the opposite — inhibitory to the longitudinal mus- 
cles and motor to the circular muscles of the bladder. This applies also to 
those to the rectum, so that you have for the bladder and rectum in one 
case motor fibers, and in the other case inhibitory fibers, and thus you have 
it under your control. 

The Osteopathic centers for these parts I have already given you. You 
remember that we work there upon the 5th sacral for the sphincter ani, 
upon the 4th to relax the vagina, and upon the 2d and 3d for the sphincter 



LANDMARKS FOR THE PELVIS. 143 

of the bladder. In passing I might also call your attention to the import- 
ance of the fifth lumbar as a center. Important, in the first place, because 
we so very frequently get a displacement there, it being the point of weak- 
ness, the junction of the spinal column with the pelvis; and important, in 
the next place, because it is a center through which we work to reach the 
hypogastric plexus. 

III. Landmarks for the Abdomen:— There are certain points about 
the abdomen which may be more or less familiar to you, which I wish to 
bring up for the sake of refreshing your memory "before we proceed further. 
These are according to Holden as before. The Linea Alba, as you know, 
extends from the apex of the ensiform cartilage to the symphysis of the 
pubes, and is the thinnest part of the abdominal wall. The lina semilunaris 
extends from a point at the level of the anterior end of the seventh rib down 
to the spine of the pubes, bulging outward; the parts between them are 
attached to the linea alba and to the semilunaris and are sometimes filled 
with some extravasation of pus or fluid. The lineas transversae are usually 
all above the umbilicus, the lower one being about on a level with the um- 
bilicus. These lines on statuary are almost always exaggerated, making the 
abdomen of a muscular man look like a chess board, which is not correct. 
These are interesting to us further from the fact that any one of these 
squares marked off by the transversae and linea alba may contract, or any 
one of them may become filled with pus, and stimulate some deep seated 
abdominal tumor or other disease. 

Marks About the Pelvis: — In the erect position a line drawn between 
the highest points of the crests of the ilia is just about on a level with the 
promontory of the sacrum. The umbilicus is sometimes stated to be the 
center of the body. But it is a little nearer the pubes than the ensitorm 
cartilage. It is not true that if a man should lie down on his back with his 
arm outstretched, a circle drawn with the umbilicus as its center, would just 
include the extremities, because this center varies with age. It will be just 
above the umbilicus at birth; at two years of age it is just at the umbilicus; 
and at thirty it is just below the pubes in man and just above in woman. Of 
course it depend also on the length of the legs. 

The bifurcation of the aorta is just about the le\'el of the promontor\- of 
the sacrum, or you might say, level with the highest point of the crests of 
the ilia. The level of the umbilicus referred to the spine is about that of the 
third dorsal vertebra. It is said that, taking a point one inch below the 
umbilicus and slightly to the left, compression may be made upon the aorta. 
This point is taken because above the umbilicus there are structures which 
might be injured by deep pressure. By feeling here you can get the pulsa- 
tion of the aorta. Cases are on record where the aorta has been compressed 
here, under chloroform, for a time sufficient to cure aneurism of the abdom- 
inal aorta. The umbilicus, as you know, is sometimes pervious, being the 
remains of the foetal artery it sometimes does not close. It is deeper and 



144 TREATMENT OF THE MATVIMAE, HEART AND LUNGS. 

wider in women than in men. As it is sometimes pervious, there may be a 
hernia here, or escape of pus, or of ovarian fluid, or of entozoa. The umbil- 
icus is also a good fixed point from which measures are taken in case of dis- 
■eases where it is necessary to compare parts of the body. Measurements 
are taken to the ensiform cartilage, to the anterior superior spines of the 
ilia, or to the symphysis. It is frequently useful in fracture to measure to 
the anterior superior spines to see how much the parts are displaced. In the 
median line behind the linee alba as we go we have first, the liver just below 
the ensiform cartilage, and extending about the breadth of three fingers. 
Second, the stomach, which, when distended, presses the transverse colon 
down and occupies the space between the umbilicus and the liver. When 
empty it recedes, leaving a slight hollow on the surface, "the pit of the stom- 
ach." The transverse colon, when not displaced, the middle of it is just 
above the umbilicus. You will frequently want to know w^here to find the 
transverse colon, and you can work on it here with a sufficient degree of cer- 
tainty. However, you must bear in mind that it is sometimes slipped out of 
position, as in enteroptosis. Cases are on record where it was found as low 
down as the floor of the pelvis. Behind and below the umbilicus are the 
small intestines, when they are not displaced by a distended bladder. The 
peritoneum, as you know, is loosel}- attached to the abdominal wall; when 
the bladder is not distended this peritoneum is in contact with the linea alba 
all the way down to the pubes. But when the bladder is much distended it 
rises, sometimes half wa}' to the umbilicus, then the peritoneum is pushed 
back by the bladder, and between the peritoneum and the abdominal wall 
there is a space of as much as two inches. A case is on record where in the 
seventeenth centur}- a blacksmith cut open the bladder there and removed 
a large stone. Of course cutting the peritoneum would have been a serious 
matter. 

When you wish to find the division of the aorta it is a safe way to find a 
point a little to the left of the center of a line drawn between the highest 
points of the crests of the ilia. And, as I said, compression can be made 
at this point. A line bulging slightly outward from this point to where you 
feel the pulsation of the femoral artery will mark the course of the common 
and external iliac arteries. The first two inches of the line belongs to the 
common iliac arter}-. Of course these things vary, the aorta may be longer 
or shorter, the bifurcation coming above or below, or the common iliac may 
be longer or shorter. There is one point in the examination of the thorax 
w^hich I failed to mention, and that is w^hat is called succession. When 
there are fluids in the body cavities, especially in the pleura, a quick shake 
and then the application of the ear to the chest wall v/ill give you a splash- 
ing sound, and that is called succussion. 

Also the Treatment of Mammae: — You will find in your practice that 
the mammae are swollen, inflamed and perhaps caked, or something of that 
kind, and especially at the menstrual period. In such cases it is a very good 



TREATMENT OE THE MAMMAE, HEART AND LUNGS. I45 

plan to free the circulation by spreading the upper ribs both in front and 
behind. Raise them well and raise the clavicle, for there may be obstruction 
to the internal mammary artery, especially at the second interspace, where 
the artery perforates and runs to the breast, you will have good success in 
treating such cases. 

General Treatment for the Heart and Lungs: — As I havesaid, this 
is just the indication of the general treatment. Dr. Harry Still, with whom 
we are all acquainted, said in an article in the last Journal that you cannot 
give a recipe for each parlicular treatment and it is foolish to try to do so. 
If you write a recipe and try to follow those directions for any one case you 
are liable to get into trouble because cases vary. As he says, there are just 
as many nervous systems as there are human faces, and just as many kinds 
of paralysis as there are nervous systems. Thus it is that I can only give 
you the general treatment for these conditions. In treatment of the lungs, 
I have already shown you how to examine the lungs. Your idea is to work 
upon the upper dorsal region, you know the center is from the 2d to the 7th. 
However, I might say in general concerning the heart and lungs, that they 
are very closely related. When you have trouble with one you frequently 
have trouble with the other, and they are so closely related to the general 
health, that if you find trouble in one place }Ou had better look also in the 
other. In treatment of the lungs, one of the chief things to do is to raise 
the upper ribs, get your fingers on the angles of the upper ribs and work 
along, pushing the shoulder down and back. Or you can set )^our patient 
upon a chair and place your knee in the back, or your thumb, in the same 
way. I have relieved congestion of the lungs very readily in that way. 

Also in treating the lungs it is a good idf^a to get the thumb in between 
the clavicle and the first rib, push the arm across the chest and back over 
the face. That of course separated the clavicle and the first rib. I have 
noticed Dr. Harry Still use that method frequently, and the idea there is to 
spread these parts, give the bloodvessels free play — the subclavian, and also 
we get an effect upon the phrenic and the pneumogastric nerves which cross 
the first rib in front of the scalenus anticus. It is also important in working 
upon the lungs to pay attention to the condition of the pneumogastric and 
of the sympathetics. Hence it is that we work in the superior cervical region 
and also upon the middle and inferior cervical ganglia of the s\'mpathetics. 
I have already shown you how to treat them. Now, your irritation to the 
vagus may of course be suf^cient to produce results in the lungs. It has to 
do with the caliber of the bronchial tubes; it gives them motor, dilator and 
constrictor fibers, so that if it is irritated it may cause contraction and gi\-e 
you a case of asthma, or something of that kind. The irritation ma\' be in 
the stomach or in the throat, or anywhere where it may irritate the pneumo- 
gastric nerve. If the superior laryngeal branch is irritated it ma\- result in 
catarrhal pneumonia. So you must look carefully to the nerves and treat 
them in the neck at the points I have indicated. The third, fourth and fifth 



146 TREATMENT OF THE HEART AND LUNGS. 

cervical are particularly noted because any displacement here is liable to 
affect the sympathetics, which has to do with the involuntary movement of 
the lungs. Then the first and second ribs and the fifth rib are particularly 
noted, but all the ribs from the second to the seventh are included, and all 
the upper part of the spine. 

I might tell you also how to treat the heart; it is largely a repetition of 
what has been said for the lungs, because the phrenic and pneumogastric also 
supply the heart, and you must always look to them. We frequently work 
upon the pneumogastric nerve here in the neck, holding against it, thus in- 
hibiting its action, to increase the beat of the heart, because we thus cause 
the inhibitory fibers of the pneumogastric to cease functioning. That is 
simply an adjutant, as I have said before, we can get abetter effect in quiet- 
ing the heart or stimulating it by working in the region of the splanchnics 
and along the upper dorsal region, especially on the left side. The motions 
I have already given you — any of these spreading motions to spread and 
raise the ribs, will relieve the heart trouble. Of course, as I have said before 
I am giving you only the general treatment. In any particular case you 
will probably find some one thing the matter, you might find the clavicle 
down and affecting the heart, you might find the first and second ribs up 
and affecting the heart, and you might find any particular rib in the upper 
dorsal region displaced affecting the heart. 

Q. Suppose you were treating a case and the patient would faint on 
your hands, by what means would }'Ou bring him to? 

A. A good way is to first get the head of the patient as low as you can ; 
just let it hang over the lower end of the table; and to refer to Dr. Harry 
again, he says to slap them, pull their hair or anything to get the blood 
started to the head; a dash of cold water to the face may be a good thing. 

Q. In case of too much blood to the head how would you go about 
treating it to throw the blood away from it? 

A. I would work first along the splanchnics. 

O. Stimulating? 

A. Well, yes, that is, I would loosen all the muscles, first, in the back, 
and then I would have the patient turn over and inhibitor press deeply over 
the solar plexus, to get the blood from the head. You will have to find out 
the cause; the cause may be an impacted colon preventing the circulation 
in the lower part of the body. Or you may stimulate the lungs and get it 
started through the whole body; your idea is to equalize the blood flow. 

Q. In case of too much heart action, what would be the quickest way 
to reduce it? 

A. The quickest way that I have found is simply to separate the upper 
ribs and raise them on the left side, and I have done it by the count, I have 
lowered it as much as twenty beats, and it stayed that way until the next 
treatment; when the patient came back two or three days later the beat was 
the same. Of course that is an exceptional case; you cannot always reduce 
it that much. 



NERVE CONNECTIONS AND CENTERS OF THE STOMACH AND INTESTINES. I47 

Q. Please give the treatment to increase the heart beat? 

A. You should inhibit the pneumogastric, thus letting the heart run 
faster; and then you would take this same movement, because the object 
when it is too slow is a stimulation, and by raising these upper ribs, whether 
it is too slow, you may increase it, or if too fast you can lower it, I have 
gotten effects either way. 

Q. Do lymphatics remain enlarged after the septic condition has 
passed away? 

A. That is a very hard question to answer. I have seen them stay en- 
larged so very long that it looked as if they might, but I do not think they 
do really. They may stay enlarged a long time, but it is possible there is 
trouble there yet, especially if the person is in poor health, 

O. Why are they enlarged in one place and not in another? 

A. Because certain parts of the lymphatic system drain certain parts 
of the body. 

Q. The treatment you have given would be good also for irregular 
heart action, would it not? 

A. There are many things that would cause irregularity of the heart. 
As I have said, a stoppage of the subclavian vein causing a periodical empty- 
ing of it, caused by a slipping of the clavicle, would cause the heart to lose 
a beat. An irritation to the sympathetics in the dorsal region would cause 
a constriction of these vessels and thus an irregular filling of the heart, caus- 
ing it to lose a beat. 

(Dr. Harry Still) I will tell you, doctor, when it originates from the 
stomach, you can press upon the pneumogastric and quiet it down. Simple 
pressure, from two and a half to five pounds pressure, for a minute and a 
half to two minutes. 

O. Would not that inhibiting movement tend to stimulate the heart? 

A. In what way? 

O. A desensitization of the pneumogastric. 

A. Not with a slight pressure. 



LECTURE XXIII. 



Today I wish to consider further the abdomen and its contents. I have 
already given you certain centers for the vaso motor control of these parts, 
necessarily so in considering the splanchnics. But there is much more that 
might be said, so I will mention some further fibers which go to these parts, 
which teach us how we can control them. 

First, as to the stomach. We know that we reach it through the solar 
plexus and through the splanchnics, also through the vagi. We must not for- 
get in dealing with the stomach that probabl}^ Auerbach's and Meiss:::~'<^-p^^^-- 
uses have to do with it as well as with the intestines. Robinson savs tha. :lie 



148 CKNTKRS AND NERVK CONNECTIONS OF ABDOMINAL ORGANS. 

gastric and intestinal secretions are under the control of Meissner and Billroth's 
plexus, aided by Auerbach's plexus. Further, note certain statements in 
Howell's Text Book: The mesentric vessels are under the control of the 
splanchnics, which contain both vaso-dilators and vaso-constrictors. The vaso- 
constrictors for jejunum are up as high as the lifth, and extend from there 
down, it does not state how far. Those for the ilium a little lower, 
and those for the rectum come off still lower along the splanchnic region. 
There are none, however, below the second lumbar. The vaso-dilators are 
present in the same nerves in these regions, and here is a chance to bring in a 
point of whether we inhibit or stimulate. I think w-e understand fully that 
point and do not think that we will split hairs over those things. However, 
the vaso-dilators are more abundant in the lower three dorsal and in the upper 
two lumbar. The vaso-dilator and vaso constrictor fibres of the splanchnics, 
ending in the solar and renal plexuses, have the vaso motor suppl}' of the liver. 
The splanchnics contain the vaso-dilators and vaso-constrictors for the liver 
probably. It is said that there are vaso-dilators also in the vagi nerves, How- 
ever, this matter is not settled, and thej^ are not perfectly sure about the exis- 
tence of these fibres. However, it makes but little difference to the Osteopath, 
since he can rule the flow of blood through the liver in other ways, as we shall 
see presently. 

Then, as to the kidneys, there are vaso-motor fibres from the sixth dorsal 
down to the second lumbar. You know that we can get, more easily, perhaps, 
on the kidneys than on any other organ a vaso-motor effect reflexly bj^ the ap- 
plication of cold to the skin. And then b}^ stimulating the sciatic nerves it 
has been found that one can get a vaso -motor effect upon the .kidneys. This 
seems to be in line with what has been said concerning an equilibrium between 
the blood flow in different parts of the bod3\ There are certain centers that 
the Osteopath works upon. The "Old Doctor" says there is a center in the 
skin, that is, a peritoneal center about one incli each side of the umbilicus, and 
that work there is beneficial both upon the kidneys and upon the intestines, 
and we often make a mere spreading motion there at the umbilicus, just press 
in deep and spread apart, not hard, for work on the renal veins and arteries. 
That always seems to have a good eft'ect in treating the kidneys. Of course 
you know the micturition center is the second lumbar but you have already 
been cautioned not to go too much according to centers; look for the lesion, 
which ma}^ be some place away from the center. 

As to the spleen, it is found that stimulation of the peripheral end of the 
splanchnics will cause quite a change in the size of the spleen, that is, in its 
bulk, but it is not really known whether it is on account of vaso-motor control 
or because of an effect upon those involuntary muscle fibres which j^ou saw 
under the microscope — you know how the capsule and the trabeculae of the 
spken are well supplied with involuntar}^ muscle fibres, and you remember how 
the oval nuclei of those fibres are easily seen. However, from the Osteopathic 
point of view, it makes little difference whether he can in one way or the other 



CKNTKRS AND NERVB CONNKCTlONS OF ABDOMINAL ORGANS. 1 49 

change the size of the spleen, so long as he does it, that is what he is after. 
He does not care whether it is through muscular or vaso-motor control, or 
whether he can work upon the splanchnics and thus reduce its size. Should 
he do that, of course he would thus change the flow of blood through it. There 
is a great deal not understood about the spleen. There is a very good Osteo- 
pathic point, however, I have often heard Mrs. Patterson speak of it, 
that is, treatment of the spleen in connection with treatment 
for gall stones. She says you can treat for gall stones and 
remove them but they will form again unless you treat the spleen on the left 
side over the ninth, tenth and eleventh ribs. And as far as I know that is 
part of the practice. I have not heard that statement refuted by any one. 
Another point as to the spleen — in treating it you will sometimes find it con- 
gested; it is like the liver in that respect, they are both liable to congestive dis- 
turbances. You may by working deep in the left hypochondriac region reach 
the spleen, but when the spleen is distended with blood it is said it is very read- 
ily ruptured; and if you find the spleen enlarged and tender I would advise j^ou 
to treat rather over the back through the spinal nerve supply than over the ab- 
domen. I think I might emphasize once more the importance of the Osteo- 
pathic work upon the abdomen. As I have already said, I think here we are 
in more danger than anywhere else of becoming masseurs. Indeed, I do not 
think we need to learn the baker's trade before we can work on the abdomen, 
and we ought to bear in mind that although we knead there, we work there as 
directly as in other paris of the body for nerve control and for the blood flow. 
And the fact that we knead the abdomen occasionally is not an}^ sign that we 
simply knead it as a masseur does. Of course there are times when we depend 
upon the mere mechanical movement, as when we begin at the sigmoid and 
work on back to loosen up the fecal contents, but our chief work is upon the 
nerve supply. I think I have already mentioned the point that b}" work upon 
the abdominal peripheral terminals we can stimulate or inhibit. I merely call 
it to your mind again, that by getting the peripheral terminals in the organs of 
the abdomen, which we can reach by pressure over the abdomen, and by get- 
ting these various plexuses from the solar down, we can get an effect upon 
these organs, and that is what we are reaching when we are working the ab- 
domen. For instance, we frequentl3' work along the whole length of the great 
intestine. What are we doing? You will remember that Auerbach's and 
Meissner's plexuses are found, the first between the muscular coats, and has to 
do with the motions of the intestines; and second, deeper in the submucous 
coat, and has to do with the secretions. Now, we ma}^ work in the region of 
the abdomen, and the beginning Osteopath, who does not understand, may 
think he is simply kneading, but such is not the fact, we are reaching termina- 
tions of nerves. You know what the plexuses look like, with their meshes, in 
the internodes of which are ganglia; they (the ganglia) are centers upon which 
you may work directly by pressure over the abdomen. Thus it is, I think, 
that we get the best explanation in regard to the Osteopath's successes in treat- 



I50 CENTERS AND NERVE CONNECTIONS OF ABDOMINAI, ORGANS. 

ing abdominal troubles, such as constipation, diarrhea, enteritis, and a whole 
list of troubles which affect man, and our success there is marked. Byron Rob- 
inson says: "Gastro-intestinal secretion appears to be carried on automatically 
by the Meissner- Billroth aided b}^ Auerbach's plexus of nerves which are sym- 
pathetic ganglia, automatic visceral ganglia." As I have said, since they are 
ganglia they are centers, and since they are automatic, they are to a certain ex- 
tent independent, and that by stimulating them, whether we go back to the 
splanchnics so much or not you get the effect, as you have an independent source 
of nerve supply here. Indeed, Robinson in making this statement, is doing so 
to establish his point that the sympathetic is largely independent in its action. 
We must, however, couple our work here with work in other places, and we 
must not forget also that the nerve centers chiefly are along the spine. We 
do our work largely here also by the blood flow. I have emphasized the nerve 
control and the blood flow. Robinson says that the movements of the intes- 
tines is largely dependent on the amount of blood in the intestinal wall. That 
is, on the amount of fresh blood which affects the parenchymal ganglia. We 
have a certain number of ganglia in these walls, they must be supplied with 
blocd if they are to act properly; that is with good, fresh blood. And by work- 
ing over the splanchnics and b}^ this manipulation process you can throw s:reat 
quantities of blood to the abdominal viscera, and thus supply these ganglia 
with an added amount of blood, and that will also help to explain how we get 
our effect upon the nervous system there. And when you have done that you 
rule both secretion and motion. Of course that has to do very closely with 
constipation, diarrhea and those things. Your peristalsis may be too rapid, 
and thus you would have a case of diarrhea, or it may be just as rapid, but as 
Robinson says, futile, and you will have constipation. You have to couple 
with that work the ruling of secretions through Meissner's and Auerbach's 
plexuses, and if they are too abundant you have diarrhea; if deficient 3"ou would 
have constipation. The fact then, there, as in other cases, is that we remove 
lesions and these secretions attend to themselves, they become normal; a change 
in the amount of motion and a change in the quantity or quality' of secretions; 
so we w^ork toward the normal. We might repeat this for every organ in the 
abdominal cavity. When we work for the uterus, the bladder, or in the intes- 
tines, or ovaries, we work very largeh^ through the nerve control, as is evi- 
denced by the fact that in case of those organs we work generally through the 
spine, along the lower part. It might be thought that the motions we employ 
in our work upon the liver are exceptions to this rule, but I think not. We 
frequently work against the lower edge of the liver, but we cannot work much 
of its bulk by our direct kneading motion there, and I think what we do there 
is the same as elsewhere, we affect the nerves as well. We affect the hepatic 
plexus of the S3mipathetics directly by manipulation there, and indirectly 
through the solar plexus, also through the splanchnics, and the vagi. If you 
will watch Dr. Harry Still 3"ou will see that he will scarcely ever omit to treat 
the vagi, when treating the liver, as it contains vaso-motor fibers for this organ. 



I.ANDMARKS FOR ABDOMEN. I 5I 

So our work in kneading is largely work upon nerve connections. There is a 
good point that I would like to note in speaking of the liver. I have seen a 
case in which there was hemorrhages from the lower bowel; whenever the 
trouble occurred there would be a tenderness and trouble about the liver, and 
the portal circulation would be stopped. There is a close connection between 
the portal circulation and hemorrhoidal. Here you have this great amount of 
blood which must pass to the abdomen and through these terminal vessels, and 
which must find its way back through the portal circulation and through the 
liver to be worked upon by it. These hemorrhoidal veins connect with the 
portal veins; so that if you have an obstruction in the liver you are very apt to 
find trouble in the way of hemorrhoids, piles, or something of that kind. So 
remember, please, that there is a further object in freeing the splanchnics, as a 
regulative process. You might say that this is true, but you might go farther 
and say that the liver in this case is a "stop cock," that it is sometimes turned 
when it should not be, and is stopping the blood and you have a congestion of 
blood at the lower bowel. You remember that the liver is particularly liable 
to congestion, and if it is congested the blood flow is retarded and you have 
a series of abdominal troubles. 

II. Landmarks for the Abdomen. — I began this last time, and wush 
to continue them to-day. In examining a patient, as you all know, perhaps, 
it is best for abdominal examination and treatment to have the patient flat on 
the back; have the thighs flexed a little to relax the abdominal muscles; have 
the head and neck slightly elevated, as much as it is raised by this table, this 
will help to relax the recti muscles. Thus you have everything relaxed, and 
unless the abdominal wall is unusually tense through its own condition, you 
have a good place to work. Then in working, I believe that beginning Osteo- 
paths "dig" here perhaps as much as in any other place. That is, they use 
the ends of their fingers. Not only Osteopaths but surgeons make the state- 
ment that that is very wrong. Holden says to use the tips of the fingers causes 
the parts to contract. Thus you defeat your own object. You should lay the 
flat of the hand on the abdomen. I have seen the worst digging over the ab- 
domen, and it is wrong, because you are not kneading and you cannot force 
any condition there, and you had better not try. Dr. Hildreth always empha- 
sizes the point that in working upon the abdomen you must work for nerve 
influence; and that is .especially noted in typhoid fever, where you have an 
ulceration in Peyer's patches, and if you try to work matters along mechanic- 
ally, you are liable to perforate the ulcerated places. 

The central tendon of the diaphragm is about on a level with the lower 
end of the sternum, about the level of the junction of the seventh costal carti- 
lage with the sternum. The right half of the diaphragm will rise as high as 
the fifth rib when the diaphragm is extended, and to one inch below the level 
of the nipple; rather higher than one usually expects to look for it. The posi- 
tion of the abdominal contents is variable. There is quite a contrast, says 
Ivoomis, between the examination of the contents of the thorax and those of 



152 I^ANDMARKS FOR ABDOMEN. 

tlie abdomen. In the first instance you have tense walls and contents which 
may vary but little, especially under physiological conditions. While in the 
other you have lose walls, you have numerous organs, some of which at least, 
vary considerably within physiological limits. So you see it is a different mat- 
ter when you go to the abdomen to examine or treat it, and you must con- 
stantly guard against wrong diagnosis by being mistaken which organ is at 
fault. Then, too, the action of the abdominal organs is more or less peculiar. 
Take the stomach at different times, it changes its position when it is distended; 
so it is with the bowels, and according to the position they assume, the others 
are also displaced; so you must bear that in mind. 

I wish to simply call to your attention the regions of the abdomen. You 
know that it is divided into three zones — the epigastric, umbilical and hypo- 
gastric. The epigastric region is bounded above by the diaphragm, below by 
a plane passing from the anterior tips of the tenth rib, and between the bodies 
of the first and second lumbar vertebrae behind. That zone is divided into a 
right and left hypochondriac regions, behind the false ribs, and the epigastric 
zone, between the umbilical zone is bounded above by the epigastric and below 
by a plane passed from the highest points of the crests of the ilia, striking a 
point between the first and second sacral spines behind. And the lower, or 
hypogastric zone is the one below the umbilical, and occupies the region of the 
pelvis. These two zones are each divided into three by an almost vertical plane 
on each side, passed from the prominence at the tip of the tenth rib to the pubic 
spine, so you have two planes. In the middle zone the regions are the right 
and left lumbar and the umbilical, and in the h^^pogastric zone the regions are 
the right and left iliac and the pubic. The lower zone is bounded below by the 
upper edge of the pubes and by the two Pouparts's ligaments, one on each side. 
It will not be necessary to detail the contents of these regions, I will refer to 
the contents as it becomes necessary later. 

As to the liver, it is found mainly in the right hypochondriac region and 
extends across into the central or epigastric region, and as far toward the left 
as the mammary line. It may extend down two or three inches, and at this 
point, behind the linea alba and the media linen is the best place to find the 
liver; it protrudes half way to the umbilicus, but you will not be able to find 
it until your hand is educated. Of course the liver may protrude lower in 
disease. I have seen a liver that weighed sixty pounds; the}' become enor- 
mously large at times. It may extend down, as for instance in tight lacings 
when it is not diseased, and you will have to judge what the general condition 
is. On the right side, where it goes a little higher, it may ascend as high as 
the diaphram, about an inch below the nipple, and below, at the lower 
edge of the lung, or as low as the tenth dorsal spine. The liver, remember, is 
a very important organ. I do not think that with all that Dr. Harry Still says 
about the liver it is any to much impressed upon our minds, because it is ex- 
tremely important to us in our practice. The gall bladder will be found just 
beneath the tip of the ninth rib on right side, but it is behind the liver, and 



I^ANDMARKS FOR ABDOMEN. 1 53 

you are not able to find it, and it is only when distended to a great degree that 
it can be noticed; even then you do not feel it directly. But we work there to 
get an effect upon the gall bladder and press its contents out. We work down 
that duct in a reversed "S" shape to the umbilicus, a little to the right. 

The stomach is one of the most variable organs of the abdomen. You all 
know how much it descends at times when distended with gas or over dis- 
tended with food. At that time instead of. simply descending, it turns on its 
axis and the greater curvature comes to the front, because the greater, curva- 
ture is not so closely attached to the lesser. When the stomach becomes thus 
distended it will push away those organs in front, and even may occupy all the 
space from the lower edge of the liver or the tip of ensiform down to the um- 
bilicus, and in such a case you are likely to have great dyspnoea and palpita- 
tion of the heart. I remember a case in which about three hours after a meal, 
the gentleman had eaten rather hearty, he had great distress in breathing, and 
his heart was palpitating, and he thought he would die surely. He called an 
Osteopath for heart trouble, but the Osteopath worked the undigested food 
on through the pylorus and worked the gas off the stomach, and the man's 
heart was all right. You will frequently meet that sort of a case, and if 3'ou 
know the probabilities you can be on your guard against it. The cardiac ori- 
fice is just below the cartilage of the seventh rib where it joins the sternum, 
and a little to the left. The stomach when empty retreats behind the liver 
and lies flat; there is no cavity whatever in it. This reminds me of a state- 
ment made by Dr. Kckley frequently, that naturally these are but potential 
cavities. The oesophagus when not occupied by the passage of food or drink 
lies with its inner surface in contact, it simply collapses and occupies as little 
room as possible. The same is true of the stomach. The pyloric orifice of 
the stomach is found on the right at the edge of the sternum about the point 
where the cartilage of the eighth rib joins; it is behind the liver and cannot be 
felt unless it is enlarged by disease. 

The spleen is on the left side, below the ninth, tenth and eleventh ribs, 
sounded by percussion over the tenth and eleventh ribs, I have already given 
you some precautions concerning it. It may become very much enlarged, 
then you can readily feel its edge, but unless it is enlarged you do not feel its 
edge. However, you can get indirect pressure on it under the edges of the 
left lower ribs, It is forced down sometimes in full inspiration. 

The pancreas is not very easily felt; it lies behind the stomach, trans- 
versely, and crosses the aorta and the spleen at the level of about the second 
lumbar vertebra. I mention it not because you will find it often; you can feel 
it only when the abdomen is very thin and the stomach entirely empty; in 
some cases of thin individuals you might mistake it for some disease of the 
transverse colon. 

The kidneys also are not readily felt. It is said by Holden that he does 
not know that he has ever felt the rounded edge of the kidney, but he says it 
is accessible to pressure as the outer edge of the erector spinas muscle between 



154 LANDMARKS FOR ABDOMKN. 

the lower ribs and the crest of the ilium. It is accessible to pressure because 
you can get indirect pressure and can know when it is tender. Of course it is 
sometimes enlarged and can then be felt. It corresponds in position to the 
lower two dorsal and upper two lumbar vertebrae. A point to know in rela- 
tion to it is that it will sometimes deceive you, or you will feel masses of 
hardened fecal matter and think they are the kidnej^, or vice versa; you must 
distinguish between them. 

As to the large intestine, you are familiar with it. The caecum and ilio- 
caecal valve both lie in the right iliac fossa, and in the right lumbar region and 
over the right kidney runs the ascending colon, and across just above the um- 
bilicus for two or three inches you find the transverse colon; the descending 
colon and sigmoid flexure are in the corresponding portions on the left side. 
You can reach all of the colon except the splenic and sigmoid flexures. How- 
ever, these are sometimes prolapsed, sometimes sunken, as Robinson states. 
Dr. Tull, of our own practice, has pointed out that this is frequently the case, 
and that prolapsus may cause constipation by acting as a mechanical hindrance 
to the passage of fecal matter along the bowel. You all know the relations of 
the bowel, and except at those two points you will be able to woik upon the 
intestine directly. 

As for the small intestine, the jejunum lies in the region behind the um- 
bilicus and is the part concerned in umbilical hernia, and it is because it seems 
to be so particularly vital that umbilical hernia is so often fatal. The point 
concerning the ileum is that it contains Peyer's patches, which are inflamed 
and ulcerated in typhoid fever; they are in the lower part near the ilio caecal 
valve, and just at the edge of the right iliac fossa. You will have to be ex- 
tremely careful in treating inflammatory conditions of the bowels, especially in 
typhoid fever and enteritis. 

The bladder is contained within the pelvis except when distended. It 
may become over distended and rise out of the pelvis as high as the umbilicus. 
And as I noted at the last meeting, when it rises it pushes the peritoneum back 
away from the wall of the abdomen, and sometimes will leave a space as great 
as two inches between them. 

I thought I had better finish the subject in this way today, leaving the 
practical examination and treatment of each one of these important organs of 
the abdomen until next time, and I shall try to finish this subject then. 



LECTURE XXIV. 

At tlie last lecture I considered the abdomen, taking first certain centers 
and nerve connections for the contents of the abdomen — the stomach, intes- 
tines, liver, kidney, spleen, and so on, calling to your attention the fact that 
although we often work mechanically upon the abdomen, our chief treatment 
there is nevertheless for the reaching of blood and nerve supply, taking espec- 



EXAMINATION AND TREATMENT OF ABDOMEN. 1 55 

ially the case of the liver and of the bowels in constipation. I then took up 
certain landmarks for the abdomen. I wish to carry the subject further. 

I. Examination and Treatment of the the Abdomen and its Contents: — 
In this I do not include the pelvis and its contents, as I shall give a further 
lecture, taking up the pelvis and its contents. Of course any 
one of these various organs become complicated with disease, and the manner 
in which it is reached and treated in the various diseases might well take up a 
lecture, but I think it best to run over the abdomen and its contents, giving 
the Osteopathic treatment for each different organ today, perhaps with the ex- 
ception of the kidney, which I will take up at the next time. 

First, as to the examination of the external parts of the abdomen. I call- 
ed your attention at the last time to the need of having the patient raise his 
knees, thus flexing the thighs slightly, also the fact that our tables raise the 
head and chest a little, thus relaxing all the parts about the abdomen, leaving 
the abdominal walls relaxed, so that you can readily examine them by touch. 
You should also take care to see that the patient is evenly disposed on each 
side, so that there would be equal tension of the abdominal walls. Of course 
you see at once that it is necessary to have the parts equally disposed. We 
use the ordinary methods of examination of the abdomen — inspection, palpation, 
mensuration, auscultation, and percussion. We use palpation and percussion 
probably most frequently. The Osteopath depends upon touch largely, and 
also upon getting the sound by percussion from the different viscera, so these 
two are the most important methods of examination that we have. We should 
first inspect the abdomen, this is best done next the skin. We note its general 
appearance; you will find in some cases enlargement due to inflation from 
gases in the bowels. In such cases it is very likely to be even. However, 
some of the hollow viscera, as for instance, the stomach, may be inflated with 
gas, in which case you would have an uneven enlargement. Further on ins- 
pection you will find whether or not any organ is enlarged. Sometimes the 
spleen enlarges enormously and pushes farther and farther down 
through the abdomen, and makes a bulging enlargement in its locality. Some- 
times, as I have said, the stomach is extended with food and gases, and quite 
enormously so. Sometimes diseases of the liver cause it to enlarge, as for in- 
stance in sclerosis of the liver. The liver protrudes down below the ribs from 
enlargement and makes a protrusion of the abdominal walls, as does also en- 
largement of the ovaries, and so on. So you should note whether or not the 
enlargement is equally disposed, as in gases in the intestines, or is at a fixed 
point, in which case you will learn by other methods how to t^ll what organ is 
affected. 

We should also note the temperature, whether or not parts are cold or hot. 
It is said that in liver troubles there are often cold spots upon the surface of the 
body, and we know that in cases of obstruction to the nerve supply at the spine, 
you can trace the cold streak on across the body. 

Inspection will reveal to you the color, which is significant. In some cases 



156 KXAMIXATION AND TREAT3IENT OF ABDOMEN. 

the linea alba becomes pale, or there may be splotches of 3^ellow color as in 
some diseases of the liver, jaundice, and in other cases. In pregnane}^ the ab- 
domen assumes a different color, brown, yellowish or black; it differs according 
to the person. You can make out the outline of an}- organ and locate it by the 
other methods of examination. 

The abdomen maj^ be distended or it may be retracted, as in tubercular 
diseases of children, where it is said the abdomen is retracted. x\nd you will 
frequently find in your practice that in thin, emaciated people, any disease 
that is wasting is liable to contract the abdomen. You wnll also find that in 
some cases it is distended. In diseases which affect the thorax, causing pain 
upon respiration, there is likely to be a change in the abdomen — an3'thing like 
inflammation of the pleura or pneumonia, there is restriction of motion and 
pain on the side affected, while the respirator}- motions of the abdomen are in- 
creased. On the other hand, in the abdomen when 5-ou have trouble which 
would cause pain upon motion, as for instance, in peritonitis, you have the res- 
striction of motion there, and increased motion in the thorax. You can also by 
this examination occasionalh' note changes? even through the wall of the ab- 
domen, as in cases where the heart has been displaced by some disease in the 
thorax. In cases of aneurism of the abdominal aorta 3'ou can find the pulsa- 
tion of the thorax. You can feel it very frequentl}', and it will sometimes be- 
come so marked that you can detect it on inspection. The caput medusae, or 
little web of veins about the umbilicus may become enlarged and engorged with 
blood, indicating that somewhere the blood is is interfered with; it is is usually 
in the liver, as in case of scirrhosis of the liver, but it may be in some por;;ion 
of the ascending vena cava. 

Palpation, as I have said, is important to the Osteopath. You can feel 
the different solid viscera in the different parts of the abdomen. As I have al- 
ready mentioned, you can feel whether or not there be tumors of any kind in 
the abdominal wall; you can by touch differentiate between those in the wall 
and those in the organs; 3'ou can tell whether or not the3^ are superficial or 
deep, fluctuating or solid. A solid tumor will give a sound such as you get 
over the liver — a flat sound; a liquid tumor will give also a flat sound, but will 
give in addition a fluctuation, which can be detected by palpation. When the 
abdomen has its walls retracted it is likely to be tense, when extended the}- are 
also likely to be tense. In other cases 3'ou may find them very flabby, ver}" 
loose, without tone. In one case there ma3^ be too much life, in the other case 
a lack of life or nerve force, and 3-0U can ce<-ect that by the feeling. You can 
also detect displacement of the parts; you must examine to see if the parts are 
in their normal position. The liver, of course, ma3^ descend considerably; the 
stomach may be displaced until it is resting upon the floor of the pelvis. The 
spleen ma3^ be enlarged and come far down. Any of the organs may indicate 
pathological changes, or be displaced or enlarged. The transverse colon, you 
know^ where to find it, just across above the umbilicus. It sometimes becomes 
loaded with fecal matter and descends, dragging with it the splenic and hepatic 



EXAMINATION AND TREATMENT OF ABDOMKN. 1 57 

flexures, and in such case you will be able to make out those flexures You 
will also be able to make out fecal tumors — accumulation of fecal matter in 
the large intestine. If there be pain in the stomach, and it increases upon 
pressure over the pit of the stomach, it is said to be inflammatory, as in ca- 
tarrh of the stomach; if it ceases it is said to be nervous. 

As I have said, the method of percussion is an important one in examina- 
tion of the abdomen. In general, percussion over parts which are distended 
with gas, gives a tympanitic sound of the abdomen, because there the gas is 
restricted within limits. Over a stomach or bowel distended you get a tym- 
panitic sound. Over the parts contained in the abdomen you get a varying 
character of flat sounds. For instance, over the liver, you know it is best 
reached right in the median line, below the ensiform cartilage, we get a flat 
sound. Here, however, over the lung, you get a higher, more resonant sound. 
You can compare sounds in that way. Over the region of the spleen we get 
the same flat sound; over the region of the stomach likewise. Over the intes- 
tine, the same, except the note is of a little higher qualify. Remember that 
in using your left hand' as a pleximeter it is best not to place the whole hand 
on the abdomen, place the middle finger oti the abdomen, and then bring the 
fingers of the right hand into line, or take the middle finger of the right hand, 
and tap gently for superficial structures, and for deeper structures more 
strongly. 

Measurements are used but little in our examination of the abdomen, but 
you can take the umbilicus as a fixed point and measure from it to the anterior 
superior spines of the ilia, to the end of the ensiform cartilage, or to the sym- 
physis pubes. 

Auscultation is made little of in the books. However, I think we use it 
more than the old profession; it is said it is of little use. Dr. Harry Still uses 
it very frequently in cases of liver trouble. He says if he finds a gurgling 
sound over the liver, there is trouble there. That gurgling sound indicates 
that there is an obstruction to the portal circulation. I have often been able 
to hear this gurgling sound. It will be quiet for a while and then you will 
hear a gurgling, and it will be quiet again and you will hear the gurgling 
again. Of course I am aware you might confuse this with the bubbling of 
gases in the stomach, .but you will have to learn bj^ general indications what 
the probabilities are. However, I think auscultation in that way over the 
liver is useful to us as Osteopaths. Auscultation is also employed to hear the 
fetal sounds in pregnancy, we will take that up later. Please remember also 
that you must take into consideration the conformation of the spine, thorax 
and pelvis, take all these parts which will in any way aft'ect the abdomen into 
consideration in your examination. 

It is difficult to say just how to give a general treatment for the abdomen, 
because we usually treat there for a specific object. However, as far as a gen- 
eral treatment would go in the abdomen, it would relax the walls. I would 
simply lay my hands on the abdomen firmly; I would not take the tips of my 



158 EXAMINATION AND TREATMENT OF ABDOMEN. 

fingers, I would not dig, I would keep my hands straight in that way; you 
know the importance of that. Thus you can thoroughly relax all the surface 
of the abdomen. We know this is a very effective movement; it is hard to ex- 
plain. As I said at the last lecture, I believe that the movements there stimu- 
late the nervous mechanism in the abdomen more than anything else; and 
mechanically of course we connot help but work the blood to the parts. It is 
said to be very beneficial. It is recommended by physicians in general just to 
tap the abdomen lightly all over. The masseur works the abdomen consider- 
ably in case of constipation, and that mechanically excites a flow of blood. 
That is, if it is mechanical, but it is hard to believe it is very largely in that 
way. There is also another movement we might include in the general treat- 
ment of the abdomen, that is, a lifting up motion, you can thrust your hands 
down in deep in the iliac fossa, and raise everything there. You can in that 
way raise the uterus, bladder and bowels. That is frequently an excellent 
method of treatment and has been used with great success. 

Next as to examining and treating the important organs contained within 
the abdomen. First, as to the stomach. It is hard to confine yourself to a 
particular part. The stomach, for instance, gives symptoms in all parts of the 
bod5\ We should notice the face, the expression and the complexion; there 
may be lack of color, a yellow or clay colored complexion. Also notice the 
eyes, the odor of the breath, the appearance of the tongue. All these things 
are indicative in troubles of the stomach. Also, of course, vomiting, the 
belching of gas, and so on. But these things are so familiar to you that I need 
but mention them to you in the treatment of the subject in this way. How- 
ever, more particularly as to the stomach locally. You have the point already 
that you can see by inspection whether or not it is enlarged. You can also 
notice by palpation whether or not it be enlarged, by percussion whether or 
not it be caused by solids, fluids or gases. Now, in treatment of the stomach, 
you know already that our chief treatment is over the splanchnics; I have 
already indicated to you the manner in which we treat the splanchnics. We 
also go to the solar plexus, treating by pressing deeply below the end of the 
sternum, over what is called the pit of the stomach, a pressure of five, six or 
eight pounds, and thus impinging upon the solar plexus. You thus get an 
effect on the stomach, since the plexus has control of the coeliac blood supply, 
as well as various other blood vessels in the abdomen. Sometimes we treat 
the stomach mechanically by raising the ribs, as we would on the right side in 
liver trouble. It is the usual motion of raising the ribs. Or you can set the 
patient up, have him take a deep breath, and put the fingers in gently under 
the ribs and raise upward and outward, thus freeing the parts in that way. 
Of course in any treatment we wish to reach the splanchnics, the solar plexus, 
and it is said there is an important point in the neck. We also reace the vagus 
along the sides of the neck and behind the clavicle, where the vagus crosses 
the first rib. At the atlas, it is said a displacement to the right will interfere 
with the right vagus. In the case of nausea we inhibit upon the left side be- 



TREATMENT OF THK STOMACH. 1 59 

tween the fourth and fifth ribs. You know how to find these interspaces. I 
simply thrust my thumb into that interspace. The spine of the scapula is op- 
posite the third, then coming down a little over an inch, you will readily be 
able to find where the interspace is; then you must raise the arm a little, just 
enough to relax those parts, and thrust the thumb deeply it that interspace. 
That is one way of treating nausea, but it depends upon the cause. I have 
had cases of nausea in which that would not succeed, the pressure gave no 
relief, but general work upon the splanchnics would give relief. That was a 
case where the patient was easily susceptible to congestion of the stomach, and 
such treatment, coupled with treatment of the vagi in the neck would always 
give relief. Treat in general the back from the third or fourth dorsal down to 
the tenth, eleventh or twelfth. Displacement of ribs may cause the same 
trouble, and you may also find a contracture along the spine on either side 
which will cause trouble with the stomach. I treated a case some time ago in 
which the only lesion I could find was a contracture of the muscles on both 
sides, there was a little heaviness of the stomach, which disappeared on treat- 
ment. You may find exquisite tenderness over the region of the stomach, and you 
can see on pressure whether or not that be nervous or inflammatory. When, 
you have gas in the stomach it shows there is a lack of life in such a way as to 
allow the food not to be digested and pass on in the usual way, but to be re- 
tained and thus to ferment and form gas. It is said to free the stomach of its 
contents to inhibit the pneumogastric between the fourth and fifth ribs, as I 
have shown you, and in that way you relax the pylorus and allow the food 
and contents to pass off. Or you can also do the same thing by mechanical 
work. I thrust my hand under the left ribs in this way and work toward the 
large end of the stomach; I bring pressure gradually toward the pyloric end, 
in that way you can force onward the contents of the stomach. You w^ork 
thus over the ribs; you can press the ribs down and you can also, in the median 
line, work very carefully on the abdomen; you can thus work the gas or liquid 
from the stomach. 

This deep prCvSsure over the solar plexus, as I have already shown, is said 
to be very efficient in case of bloating with gas. In some way the stimulation 
of the plexus allows the gases to be condensed, and that is one of the eflicient 
treatments in cases of gas on the stomach or bowels, The ninth and twelfth 
ribs on the left side have been found displaced in some cases. In cases of pret^- 
nancy, menstruation or such troubles, you will frequently find a sick stomach. 
Of course that is reflex. To treat a sick headache which is caused from the 
stomach, you must first apply your treatment to the stomach, and thoroughlv 
stimulate the parts there before attempting to work on the head. In case of 
female troubles, you may give relief there, and it is well to do so, but of course 
you must work upon the local trouble at its appropriate centers to relieve it. 

Now, as to the liver. First as to its examination; you cannot see anything 
by mere inspection; the best way is to percuss the region of the liver. If vou 
find behind the linea alba that the left lobe comes down as much as three inches,. 



l6o TRKATMKNT OF THK LIVKR. 

the liver is either prolapsed or enlarged, and you will have to determine which 
is the case. By percussion along the lower edge of the ribs and up over the 
ribs as high as about an inch below the nipple you can make out the outline of 
the liver. You will also frequently find that it is quite tender, and it becomes 
extremely so in some cases. Dr. Harry Still sa3^s that in case the liver is ex- 
tremely tender he always looks for diarrhoea. The easiest place to find whether 
or not the liver is tender is in the median line behind the linea alba. Of 
course the liver is complicated with general troubles, as for instance, in con- 
stipation and diarrhea; these two things indicate derangement of the liver. In 
diseases of the liver you will frequently notice yellow splotches upon the skin, 
oerhaps on the face, perhaps over the abdomen; j^ou will find a rushing of 
blood to the head, double vision, or day blindness. You must learn in general 
what the complications are, when the liver is deranged. I have noted already 
the fact that auscultation is frequently used in examination of the liver. Just' 
place the ear very lightly over the region of the liver, at the edge of the liver 
you will be able to make out a gurgling if there be such there. Now, as to 
the treatment of the liver itself. I have already shown you how w^e treat the 
liver — the raising of the ribs as shown here; or have the patient take a deep 
inspiration, and then raise the points of the ribs. Dr. Harry Still frequently 
employs that method — reaching under the tips of the ribs and raising them 
upward and outward. Of course 3^ou will have to be careful in doing that. 
We also work upon the liver frequently in this way: you can place one hand 
beneath and thus raise the side of the chest toward you, and with the other 
hand press down with the flat of the fingers against the liver. Thus you can 
press the ribs down, and this motion is ver3^ good. 

I explained what I believed to be the theory of such work the other day. 
Of course in treating the liver we must remember that there are vaso-motor 
fibers in the'pneumogastric, and we must not omit to treat it. We also treat 
the splanchnics, as they contain the sympathetic supply; also the solar plexus. 
Those are the chief points for reaching the blood and nerve supply of the 
liver. Also the point that I gave 3^ou, upon each side of the umbilicus, it is 
said that pressure here applied not too deeply, a fairly firm pressure, will 
reach those centers and influence, first, the kidneys; second, the liver: and 
third, the bowels; you can get an influence upon all those organs in that way. 

As to the gall bladder and duct, they are extremely important to us. As 
I have said, the gall bladder is behind the liver at the point of the ninth rib on 
the right, but we can get indirect pressure upon it by working up under the 
point of the ribs, for instance, 3'OU can sometimes feel the prominence made 
by the fundus. The first thing in working upon the gall bladder is to work 
against the fundus, and we can work upon it by working up under the ends of 
the ribs. The duct we have already spoken of, it lies upon the right in a re- 
versed "S" being just over the umbilicus, to the left, and the lower limb of 
the "S" around the umbilicus to the right where it empties into the duodenum. 
-Since the gall bladder and its ducts are both lined with mucous membrane and 



TRKATMKNT OF THE LIVER. I 6l 

like mucous membranes in other parts of the body it is liable to catarrh, it fol- 
lows that catarrhal inflammation may sometimes travel from the pharynx, 
through the oesophagus, stomach and intestines and up into the gall bladder 
You will then have an increased secretion of mucous in the gall bladder and 
duct, and may have a mucous plug shutting up that duct, resulting in jaun- 
dice. Or you may have a gall stone formed, said to be a precipitation of the 
cholesterine of the bile; these solidify and close up the duct. In treating for 
them we work as I have shown you, against the fundus of the bladder and 
along the duct, simply trying to force them out. Sometimes they are quite 
hard, and at times they are quite soft and can be crushed in the duct; this has 
to be done without any violence, however. It is said that in treating for gall 
stones, you should not endyour treatment without raising the ninth, tenth and 
eleventh ribs on the left side for the spleen; that stimulation of the spleen 
seems to prevent their formation, and results gotten there seem to prove that 
line of argument. 

Q. In case you were treating the vagi in the neck and the patient should 
be taken with a nervous chill or something of that kind, at what point would 
you treat to counteract that? 

A. I would treat along the spine, a general treatment. It is said that a 
rubbing up the spine is good for a chill, and I would work there for a chill, 
stimulating also the heart and lungs to stimulate the circulation. 



I.BCTURE XXV. 

At the last lecture I took up the examination and treatment of the abdo- 
men and its contents, first showing you how we treat to aifect the abdomen in 
a general way, and then I started to take up the contents of the abdomen one 
after another. I thought I should get as far as the intestines the last time, 
but failed to do so, and that will be included in today's lecture. I will also 
take up the consideration of the pelvis today. 

I. Some nerve connections and centers for the intestines and pelvic con- 
tent'i. — I have already mentioned some centers, in the list given, and we should 
always consider those conters along the spine in connection with the different 
parts. There are certain vaso motor fibres noted in Howell's Text Book: 
First, for the external genital organs there are two groups, one coming from 
the lumbar region, and the other from the sacral region. Tho.se of the lumbar 
from the secjud, third, fourth and fifth lumbar nerves, 
running forward in the white rami communicantes: thev pass 
tbrough the pelvic plexus and pudic nerve and thus reach 
their termination. You will see later that this pudic nerve is im- 
portant to us in our treatment; you know it contains some vaso- motor fibres for 
the external genitals. As for the sacral group, these leave the anterior roots 
of the nerves in the sacral region. A stimulation here causes a dilation of the 



1 62 nerve: centers and connections of PEI.VIC ORGANS. 

vessels of the external genitals. As to the internal generative organs, vaso- 
constrictors for the Fallopian tubes, uterus, and vagina in the female, and for 
the seminal vesicles and the vasa deferentia in the male, are contained in the 
sacral nerves. Also we get some fibres from the second, third, fourth and fifth 
lumbar nerves, just as we had vaso-motor fibers for the external genitals. We 
want to know the following points: That the second, third, fourth and fifth are 
the same for the external and internal genitals; that we get vaso-motor fibres 
from both; that we also work, as you will see later, in consideration of the pel- 
vic contents, frequently upon the sacral region, springing the sacrum, relaxing 
the ligaments about it, and also stimulating the peripheral terminations of the 
nerves in the muscles along the sacral region. It is said that the first point to 
which one should go in treatment of female troubles is the fifth lumbar; that 
that is is the important point, not particularly an important center, but the 
place where it seems a displacement is likely to occur. Then, too, you know 
that that is the center for the hypogastric plexus. The next important point 
is the second lumbar, which is the center for blood supply to the uterus. After 
that in treatment of female troubles the next important point is between the 
tenth and eleventh dorsal vertebrae, the blood supply to the ovaries. 

Hilton makes a point that the muscular abdominal walls, the peretoneum 
lining all of these walls, and the skin over them, are supplied by branches of 
the same nerves, as we have already mentioned the point he makes that a joint, 
the muscles moving the joint, and the skin covering the insertion of those 
muscles, are all supplied by branches of the same nerve. Hence, it is, he says, 
that retraction of the abdominal wall and great tenderness of the skin over the 
abdomen is found in cases of peritonitis, the inflammation reaching the termi- 
nal filament in the peritoneum, extending thus from the branches irritated, 
the sensory branches to the motor branches, causing the abdominal walls 
to contract, influencing also the external cutaneous branches, 
causing a feeling of pain upon touching the abdomen. That 
brings to mind the point that has already been 

mentioned, and which was brought up in clinics not long since. The ques- 
tion was, can you impinge upon the sensory part of a nerve and thus affect its 
motor fibers. I think that such points as this answer that very clearly. Hil- 
ton also instances a case of peritonitis, in which the cause was obscure. It was 
not severe, but it was hard to tell at first that it was peritonitis. The patient 
had been having pain in the abdomen, it was bilateral, there was no heat at the 
part; he therefore decided that the cause was either central or double, and since 
there was no heat there, he examined for spinal trouble. He examined thor- 
oughl}^, but could not find any evidence of disease of the spine; he then made 
his examination for tluid in the abdominal cavity and found that there was 
fluid in the abdominal cavity, irritating the nerves and causing this pain upon 
the abdomen. 

In considering the pelvis, I thought it would be interesting to bring out 
some further points considering nerve connections there. I noted the point 



:nkrve: centers and connections of pelvic organs. 163 

the other day that ia trouble of the uterus, ovaries, etc., the sympathetic fila- 
ments supplying these parts carry the irritation back to the spinal nerves, and 
thus it may go down the sciatic, or might influence the muscles at the lower 
part of the spine, causing lameness there. A further point is noted with con- 
siderable interest, and it may be useful to us in many cases. Hilton noted a 
case in which a gentleman came to him with what he supposed to be trouble 
of the bladder and urethra. He had pain externally in the genitals on one side 
and he traced the pain very definitely along the peripheral branch of the pudic 
nerve, along the ramus of the pubis and ischium to the genitals. Hilton traced 
the nerve carefully back and discovered at the tuberosity of the ischium on the 
side affected a thickening of the tendons. The gentleman had been used to 
sitting upon a hard uneven seat, and gradually there had formed a thickening 
of the tissues which had impinged upon the nerves and caused this pain. As 
you know there is a bursa over the tuberosity of the ischium for its protec- 
tion, and irritation or excessive use, or sitting upon a hard seat, or weight un- 
evenly distributed, will cause similar troubles. It may be an Osteopath would 
go back to the spine, but if he did not find a lesion there the next best thing 
would be to go to the nerve, and 5:ee, especially at the tuberosities, if there 
was not some trouble. 

II. Landmarks about the Pelvis and PsRiNtiUM: — You are all famil- 
iar with the location of the anterior superior spine of the ilum. It is used by 
surgeons as a point from which to measure the length of the limbs, which 
you know is quite a hard thing to do successfully, so many things make 
changes in the length of the leg. Holden, however, says he finds it more re- 
liable to take a tape line and have the patient hold it between his teeth, then 
measure a fixed point on the limb somewhere, (he measures to the inner malle- 
olus) not swinging the tape from one side to the other, but making an inde- 
pendent measurement each time. You will find that in work upon the pelvis, 
and in examining the legs you will have to see that the patient lies perfectly 
straight upon the table. One good way is to ascertain whether or not a line 
drawn transversely between the anterior superior spines is at right angles to the 
axis of the body; you will have to see that the patient is perfectly straight. It 
is also helpful in making a diagnosis of hip joint disease, or disease about the 
hip joint, to place the thumbs firmly upon the spines, one upon each, then grasp 
beneath the trochanters with the finger, and you will be able to examine in 
that way for two things; whether the two sides are alike, and at the same time 
you can press backward upon the spine; a tenderness behind gives evi- 
dence of disease, frequently in the sacro-synchondrosis. 

The spine of the pubis is also familiar to you in its location. It is not al- 
ways easy to find; sometimes j^ou can find it by pushing the lower abdominal 
skin backward toward the direction of the spine; if not successful then, by 
abducting the limb slightly, causing the adductor longus to be tensed; you can 
feel its attachment to the spine. Frequently it is difficult to distinguish be- 
tween two kinds of hernia, the inguinal and femoral, but is said that in case of 



1 64 LANDMARKS ABOUT THE PELVIS AND PERINEUM. 

inguinal hernia the spine of the pubis is on the outside of the neck of the sack, 
while in case of femoral hernia it is on the inside. That may be a helpful 
point. 

The perineum has a ligamentous and osseous boundary; it is bounded by 
the rami of of the pubes and ischia, the tuberosities of the ischia, and the great 
sacro-sciatic ligaments and the tip of the coccyx behind. It is important in 
our practice, I have not seen the point mentioned in the books, that we should 
note the shape of the perineum. In the normal, healthy perineum there is a 
slight bowing upward to hold up the pelvic contents. In disease there may be 
a relaxation of the ligaments of the perineum and a dropping down of the con- 
tents, causing a bulging of the perineum. Of course the bulging is slight 
whether it is normal or abnormal, but it is important; those things sometimes 
cause a great deal of trouble, even though the variation from the normal posi- 
tion may be slight. In treating such a case we go to the pubic nerve where it 
crosses the spine of the ischium, stimulating just where it crosses the spine, 
and its perineal branches runnine: to the perineum cause a contraction; also by 
stimulating the lower sacral nerves, causing a contraction of the coccygeus 
muscle we thus help it to raise the bow^l and the pelvic contents. 

Along the region of the sacrum we find the posterior superior spines of the 
ilia. They are on a line which would pass horizontally through the second sa- 
cral spine and they also mark the middle point of the sacro-iliac synchondrosis. 
We can find opposite them the spines of the sacrum, down to the last, and two 
tubercles upon the last just where it ends. The third sacral spine it is said is 
the limit of the extent of the membranes of the cord in the spinal canal and of 
the presence of the cerebro-spinal fluid in the canal. 

The prominence of the gluteti muscles often become significant. That is, 
it is said that in persons of ill health these muscles become relaxed and flaccid, 
and that wasting upon one side is an early symptom of hip jomt disease, which 
is very difficult to diagnose. The fold of the buttock is the name given to the 
line just below the edge of the gluteus maximus muscle, between it and the up- 
per back part of the thigh, and it is said that in this fold is the easiest place to 
bring pressure upon the great sciatic nerve. Taking a point between the tro- 
chanter and the tuberosity of the ischium, and press in deeply, rather nearer 
the tuberosity than the trochanter, you can impinge upon the nerve. Often a 
person sitting sidewise will have the leg become numb because of impingement 
upon the nerve; you may sit upon the edge of a bench and injure this nerve so 
as to cause sciatica 

A line drawn from the posterior superior spine of the ischium to the top 
of the trochanter, when the thigh is rotated forward, marks at the junction of 
the upper with the middle two-thirds, the emergence of the gluteal artery from 
the great sacro sciatic notch, and it is at that point that you can determine the 
top of notch. The pudic nerve and artery, as you know, both cross the spine 
of the ischium. This is located by drawing a line from the same point, the pos- 
terior superior spine of the ischium, tb the outer side of the tuberosity of the 



EXAMINATION AND TREATMKNT OF INTESTINES. 1 65 

ischium, then taking the junction of its outer and middle third, you have where 
this vessel crosses the spine, and there you can impinge upon it. Of course 
the nerve accompanies the artery, and that is an important point to the Osteo- 
path, for there you can stimulate that nerve and cause contraction of the peri- 
neum. The point is mentioned that modern methods of sitting, enjoying one's 
self in an easy chair, or upon soft cushions and the like, causes the parts to be 
supported more by the soft parts about the hips, so that pressure could thus be 
brought upon these blood vesssels, especially the pudic, and that a hard chair 
is much more healthful. Upon the condition of these nerves depends the blood 
supply to the interior pelvic organs. Pressure, brought by sitting, upon these 
vessels determines the flow of blood into the pelvis and is a fruitful source of 
uterine and pelvic disorders. 

III. Examination and Treatment of Abdominai, Contents — (Con- 
tinued) — As to how to diagnose troubles of the intestine, you will learn that 
better in symptomatology, when you come to the special diseases. However, 
I can show you something, pf the methods employed. It is obvious that when 
you have a case of constipation, diarrhoea, flux or anything of that kind, where 
the trouble is. The nerve supply for the intestine, as you know, is through 
the sympathetics from the upper dorsal down; that is, from the third dorsal 
down, because we get the vaso-motors to the mesenteric vessels from the 
splanchnics, and we reach the sympathetic connection all the way down the 
spine. I have already shown you how to treat those parts. We also reach it 
by working on the solar plexus, and you can get an immediate effect by work- 
ing upon the centers either side of the umbilicus. In all these ways we may. 
reach the intestine. Stimulation of the sympathetics will inhibit the vermicu- 
lar motion of the bowels, while stimulation of the pneumogastric will increase 
the motion. Of course you know that in working upon the region of the in- 
testines we also work upon Auerbach's and Meissuer's plexuses. There is a 
treatment that we use sometimes in case of constipation, trouble with the 
bowels, that is, we begin at the left iliac fossa, and by deep pressure over the 
line of the colon, work gradually upward along the left lumbar region where 
the intestine runs over the kidney, then across just above the umbilicus, and 
down the right lumbar region; that is, we work there largely for mechanical 
effect; to soften the fecal matter and work it outward as we go, beginning near 
the orifice. Of course it is impossible not to impinge upon the nerve plexuses 
and not to influence iVuerbach's and Meissuer's plexuses in working upon the 
intestines there. You will very frequently, according to the season of the 
year, which will soon be upon us, come across cases of cramps and diarrhea. 
It is not, however, limited to particular seasons of the year. I have found cases 
of bad cramps in the intestines where it was almost periodic, you might say. it 
came on every two or three months; after some indiscretion, as over eating or 
eating of too rich food the patient would have those attacks. The spasm, as 
near as I could make out, is most liable to occur in the transverse colon; it 
starts there first and there is an irritation, from that point the irritation will 



1 66 EXAMINATION AND TREATMENT OF INTESTINES. 

pass down through the bowel, and the next morning or the second morning 
you will have tenderness and pain down in the region of the right iliac fossa. 
It has been mj^ experience that it takes that course; and from there it will 
spread over the bowel and you will have a case similar to an inflammation. I 
think it is an inflammation, from the fact that the patient usually passes 
mucous upon convalescence. This trouble can be very readily stopped. It is 
done by inhibiting the splanchnics; you can have the patient sit upon a chair 
and hold closely all along the region of the splanchnics, just by a deep pres- 
sure, hold at each point for a minute or two and you ^vill be able in that way 
to stop the spasm. I have seen it disappear in a very short time. The same 
thing can of course be done by placing one knee along the splanchnics and 
drawing the arms up and back. Of course that brings deep pressure, and very 
forcible, against the splanchnics, and inhibits them Particularly it is the up- 
per splanchnics we wish to reach, but it does no harm to work on down the 
spine. It is not a bad idea to adopt this twisting motion, because it there is a 
tightening and irritation of those nerves, you will be able to relax them in that 
wa}^ and I have been able, in that way, to get very good results with such 
trouble. There is another thing that comes to us very commonly, and that is 
flux and diarrhea. The center for the bowels in such cases, it is said is oppo- 
site the lower two ribs on each side, but we work by inhibiting, by getting 
deep pressure, just as I have shown you. Have the patient sitting up, and 
you can place your knee against the eleventh and twelfth ribs and pull the arms 
up and back, and then against the ocher side; you can thus inhibit the peris- 
talsis. It is undoubtedly through the sympathetic connection there, and in- 
hibition of the sympathetics. I never omit in such cases to spring the spine, 
and to spring it strongly; that is one of the cases where we have to give a 
strong treatment, so I have the patient on the side, reach under the spine and 
spring the column up toward me strongly, all along the lumbar region. It is 
side, very helpful also to adopt this method in such cases: with the patient upon his 
have the thighs bent up and get a good hold against the sacro-iliac articulation, 
and spring enough to raise the patient from the table. I think you can see 
from the motions I have given you about what you can do in such cases. Also 
in such cases never forget to work upon the liver; I have already shown you 
how to reach that, and influence it, especially the flow of the bile. It does 
not make much difference whether the patient is constipated or whether he 
has flux or diarrhea, the presence of bile in the intestines in undoubtedly 
helpful. In cases of constipation the "Old Doctor"* says the bile is nature's 
aperient, and that it helps to stimulate the peristalsis. In the other case the 
action of the bile in the intestine seems to be such as to allay the irritation or 
the inflammation. It simply amounts to restoring the normal; in one case you 
have a lack of bile, and the normal action of the bowel seems to be dependent 
upon it for stimulation. In the other case you must work to cause a flow of 
bile also. Just why it works differently it is very hard to explain, unless, as I 
say, it is the normal condition of the bowel to have the bile present at certain 



TREATMENT OF INTESTINES. 1 67 

intervals, and if that bile is lacking, you may have various effects. I had a 
very interesting case not long since, a gentleman who some years ago, I think 
about three, had a case of bowel trouble, diarrhea and considerable trouble at 
that time, severe trouble. Since then he had had pain after eating, about 
three hours after a meal, also bloody flux at stool. This had been troubling 
him off and on ever since he had the old trouble. Upon examination the only 
difficulty that I could find was tightening along the lower lumbar region, mak- 
ing a smooth place in the spine, which I have already described to you. Be- 
sides that the eleventh and twelfth ribs on each side were approximated, forced 
together, so that you could feel but very little interspace between them In 
the first treatment I did all I could to spring the lower part of the spine and to 
relax the tissues in that region, and also adopted motions already shown to 
separate the eleventh and twelfth ribs. After that treatment the pain after 
eating ceased and he did not have any return of it. The next treatment w^as 
given about a week later, and I repeated the same process at that time. Since 
then, at the last information about a week ago, he had had no return of the 
trouble, and that was about two weeks after the treatment. Now, that was all 
very simple, it was merely looking to see where things had departed from the 
normal, and restoring them and relieving the tension upon the parts. One 
thing that I did in that case was to relax the ligaments in this way, by spring- 
ing the lumbar region. You will learn these motions and how to apply them. 
It seems that in some certain kinds of trouble one motion is more efficacious 
than another, and you will also find that it varies with your patient. I also, 
in that case, took what I call the quarter turn to relax the tension between 
those ribs. That is, I got the legs of t ■ e patient in my arms, and turned him 
until his body was about three quarters off the table, then let him slip down 
and around back onto the table in that way, straightening the legs. I think 
you understand, as I showed you the motion before. I think I mentioned the 
point that a displaced coccyx is sometimes the cause of diarrhea. There is 
also another important treatment in the case of intestinal troubles. That is, 
you may raise the intestines almost bodily, especially in cases where there is a 
relaxation of the abdominal walls, where you find the transverse colon des- 
cended below the umbilicus, and then by pushing in deeply above the pubes 
you can push upward and outward and thus raise the abdominal contents. 
Another motion is to have the patient lie on the side and then to reach deeply 
into the fossae and work in on the right side under the caecum, follow it up 
and spread apart, and then work in the same way on the left to raise and spread 
out the sigmoid flexure. That is frequently a very good way in which to 
treat troubles of the intestine, especially where you expect any sort of relaxa- 
tion allowing the bowel to drop in that way, and that is in almost every case 
where you have had intestinal trouble that has been going on for some time. 
There is almost always a relaxation of those ligaments, and prolapse of the 
bowel. You will remember that the defecation center is at the second lumbar, 
and the "Old Doctoi" has shown me a good point in how to reach the second 



1 68 TREATMENT OF INTESTINES — SPI.EEN. 

lumbar. He places the thumb of one hand just over the trochanter or just 
above, and then finds the second lumbar by counting carefully up from the 
fifth lumbar, and then while he presses upward the trochanter of the patient 
with the hand that is on the hip, he presses inward with the other hand and 
gives a turn to the second lumbar. Then taking the same point for one hand, 
and reaching under and raising the patient's head and shoulders you can thus 
very effectually relax the second lumbar. You see that makes the second 
lumbar a fixed point and you swing the upper part of the trunk around it, and 
in the other place you swing it in much the same way. Robinson makes quite 
a point of the fact that what he calls the fecal reservoir, viz., the left half of 
the transverse colon and the descending colon and the sigmoid flexure, are all 
supplied by the inferior mesenteric ganglion. This inferior mesenteric gan- 
glion is found on the inferior mesenteric artery, and you can reach it by work- 
ing a little toward the left about two inches below the umbilicus. We have 
very good results in cases of constipation by working there and stimulating 
that plexus; the inferior mesenteric ganglion of the sympathetic. In speaking 
of the use of bile it is not only helpful in cases of diarrhea, flux and constipa- 
tion, but that is our way of destroying entozoa, tape worms, or seat worms, or 
parasites of any kind, it is said it is always beneficial to stimulate the flow of 
bile iu such cases, and very frequently that is all that is necessary, thus caus- 
ing the worm or whatever it is to be acted upon by the bile. In treatment of 
constipation you will frequently find that the patient is simply in trouble be- 
cause he has not drank enough water, and that is why very frequently it is 
necessary to prescribe so 'man \- glasses of water in a day, you can say mineral 
water or spring water, or something of that k;ind, so they will think you are 
particular about it. It is said that the explanation of why drinking of water 
is beneficial in cases of constipation, is that when the stomach is empty (the 
water should be used one half hour before breakfast) that the water passes in- 
to the intestine and is easily absorbed by the lacteals and carried to the portal 
circulation, and that stimulates the flow of bile and increases its quantity, and 
thus it affects the fecal contents. 

As to the treatment of the spleen, I have already shown you that at the 
last lecture. You will find that there is a tenderness along the spine behind, 
and in front along the region of the ninth, tenth and eleventh ribs on the left 
side in such cases, and Dr. Harry Still tells me that in- such cases it has been 
his experience to find a cold, clammy perspiration, especially on the leftside of 
the body. What we do there I have already explained, raise the ninth, tenth 
and eleventh ribs, and work carefully under the tips of the lower ribs in front. 
As I explained at the last lecture, the vaso motor supply of the spleen is not 
understood, but it was seated that we changed its size by work upon the peri- 
pheral terminals of the splanchnics, but it is understood also that there is a 
center in the medulla. There is also a center in the medulla for the intestines, 
and it seems that some trouble with the atlas, or some tightening of the liga 
ments may impinge upon the sympathetics and thus get an effect either 
through the medulla or directly through the sympathetic system. 



tr:^atmknt of the kidneys. 169 

IvKCTURE XXVI. 

At the last lecture I was following the subject of examination and treat- 
ment of the abdominal contents. I shall pursue that subject further today, 
taking up also the pelvis, its examination and treatment, particularly with re- 
gard to slips or twists of the pelvis as a whole and of the innominate bones. 
We had gotten as far as to the kidneys. To treat the subject in a general way 
we can only say that in general where there is trouble with the kidneys there is 
a tenderness in the back, frequently contractures or displacements along the 
spine. There are general symptoms which you will learn to recognize, and 
which you will find by urinalysis, which you have learned elsewhere. Also such 
things as odor of the breath, and condition of the tongue, it is said that a fur- 
rowed or ridged tongue indicates kidney disease. The complexion, and various 
things of that kind, are indications of kidney disease; also fever, especially fol- 
lowing suppression of the urine, since then the system is poisoned. Often 
you have painful micturition due to bladder or kidney disease; and so on. The 
chief thing, however, is how we, as Osteopaths, treat the kidney. The nerve 
supply is largely through the renal splanchnics, the last splanchnic rising oppo- 
site the twelfth dorsal. I have already shown you how we should work there. 
Also the second lumbar is the center for micturition, and the effect that we get 
by working upon the second lumbar is probably a vaso-motor effect, since you 
know that vaso motors leave the spine all the way down, especiall}- from the 
sixth dorsal to the second lumbar, having both vasodilators and vaso-constric- 
tors within those limits. A lesion at the atlas also affects the kidneys, probably 
by an effect upon the renal center in the medulla. Hence, we alwa3's examine 
to find whether or not the atlas is displaced, and if not, we are able to get an ef- 
fect upon the renal center in the medulla by working on the superior ganglion 
and in the sub-occipital fossa. Hence, we get a sympathetic effect. Now, a 
lesion in the cervical region, especially at the upper part, at the atlas, may affect 
the kidne}^ directly through the sympathetics, and indirectly through the center 
in the medulla. 

One of the best ways to treat the kidneys is the method employed b}^ Dr. 
Harry Still; have the patient upon the back, with the knees raised, you then 
have all the muscles relaxed. Then by lifting along in the region of the 
lower splanchnics, simply raising the patient upon the fingers and springing 
outward as you go, you relax the contractions, and spring the ligaments and 
get a general stimulating effect upon the kidneys. You will find that. I think, 
one of the best treatments. Another treatment is to press here at the linibiliciis. 
and by pressing deeply, spxreading and stimulating probably the sympathetic 
ganglia, upon the renal ves.sel, as there the renal ganglia occur. Also the cen- 
ters which I have before mentioned, occuringone on either side of the umbilicus 
in the skin, called perintoneal centers, have an effect upon the kidneys, and I 
do not doubt but that we get some sort of a mechanical eft'ect also in this way, 
by relieving any pressure which may be brought upon the renal vessels. Of 



1 70 TREATMENT OF KIDNEYS. PEI^VIS. 

course there are other things that may bring mechanical pressure upon the renal 
vessels, such as aneurism of the abdominal aorta, an enlargement of vSome one of 
the abdominal organs, or tumors, and in those cases you must direct your 
treatment to the conditions which are producing the disease. You will fre- 
quently come across cases of renal colic, that is, stone in the kidney or in the 
bladder, and in the passage of the stone down the ureter the pain is excruci- 
ating. Renal colic is the name given to the pain caused by the passage of the 
stone. Of course the deposit varies, sometimes the stone is large, and it varies 
in composition. I do not need to go into that, as that is not the purpose of 
this lecture; sometimes it is a crystal of uric acid about which deposits aggre- 
gate, and in the long run there is quite a large stone. As to the proper treat- 
ment for it, when a stone is started from the pelvis of the kidney down the 
ureter it is our treatment to work along the course of the ureter and to work it 
back, if it is possible, because you can dissolve it as well in the kidnej' as you 
can if you press it on down to the bladder. Of course if it has started on down 
the ureter and cannot be worked back, it should be worked on down into the 
bladder. You know what the course of the ureter is, from about the level of the 
umbilicus, a couple of inches on each side, down obliquely to the base of the 
bladder. Of course I do not mean to say that you can feel the ureter by work- 
ing along its course. You can however, bring deep pressure along its course, 
and thus work upward any stone which mav be in it. That is frequently 
done. In such cases our treatment would be directed to stimulating the gen- 
eral health of the kidnej^s, that is, to increase its healthy action, so that these 
stones could not be formed. If your kidney is acting properly you will not 
have real calculus. Not only would we take care of the renal splanchnics, and 
the second lumbar, but all along the lumbar and lower dorsal region. I have 
tried to teach you that your lesion may be at the center, but it may be above 
or below, causing trouble with the kidneys. In general our success with kid- 
ney troubles has been very good. Of course when you come to general treat- 
ment, drinking of hot water, bathing, and exercises, are all good. There are 
some who believe that it is beneficial to, as they call it, flush the kidney every 
morning by taking a drink of water before breakfast. That acts upon the 
kidneys as well as the bowel. It is probable that the increased excretion 
would tend to keep the kidneys flushed. Byron Robinson notes that fact, but 
does not give it the weight of his authority . 

As to examination and treatment of the pelvis, that is an important thing 
in our work. The pelvis or the innominate bone may be slipped in different 
directions, and the correction of these slips gives the Osteopath very gratify- 
ing results indeed. The whole pelvis may be slipped forward or it may be 
tipped backward in the first place, or the whole pelvis may be twisted from 
side to side, and you would have tenderness on each side at the sacro-iliac 
synchondrosis particularly, and you will also have tenderness at the symphysis, 
for the reason that the sacrum is broader in front, as you see, and movement 
of the parts then would tend to cause the wedge-shaped sacrum to act upon the 



TREATMENT OF PELVIS. I /I 

innominate bone and press them apart, thus you would have a strain at the 
symphysis, and you would have tenderness here just at the symphysis. In 
examining for these troubles, always pay attention to the symphysis. You 
would always have tenderness where the ligaments bind the back part of the 
sacrum to the innominate bones. If it is tilted backward, your hand when it 
has become able by touch to detect the departure from the normal, will find 
that the posterior portions of the crests of the ilia are projecting farther back, 
and when tilted forward, that the posterior portions of the crests are tilted 
farther forward, so that you will come to find out whether the position is cor- 
rect when you examine by palpation, which is our general method. Now, if 
the pelvis is twisted from side to side you would find a tenderness on each side, 
and at the sacro-iliac articulation as wellasa tendernessin front, at the symphy- 
sis, and you will have to judge which is the case. Of course if the pelvis is 
twisted you can by examining the back get an indication of which way it is 
twisted. It will take v^ery close work in examination and you have to give it 
your careful attention. The reason why you would have tenderness on each 
side is that in a twist of the pelvis from side to side you would have both liga- 
ments thrown on a strain, one diagonally backward, and one diagonally for- 
ward, and you would get tenderness in each case. When you have these 
slips and twists, of course you have something then that is affecting the sacral 
plexus of nerves, and the result may be pain down the legs, and you may have 
sciatica in one or both limbs, and the most fruitful source of pelvic disorders, 
especially of female troubles, is a slip of the innominate, as you will see later. 
So your examination, then, would include both the symphysis in front, and 
the articulations behind, coupled with an examination for general disorders of 
the pelvis and even down into the limbs, 

Now, as to how to treat the pelvis if it is tilted forward. One of the best 
ways that I know of is to set the patient on a chair, and then by putting the 
knee in the sacrum behind, we can reach in front and get hold of the anterior 
superior spines and pull backward; it does not take a great deal of force, and 
at the time it is quite a good movement to pull the patient forward. If the 
pelvis is twisted, of course then the lower part of the body in respect to the 
waist is turned to one side or the other. One of the best ways to fix that is to 
set the patient on a chair and get the arms up over your shoulder, you can sit 
right down on their knees, and give a twist to one side or the other, simply 
making an effort to move the whole trunk of the body upon the articulation 
with the pelvis, and as that is rather a moveable point, and often the point of 
displacement, you can readily turn it from side to side. You can also move 
the whole pelvis forward by some such motion as this: have the patient lying 
upon his side, you can make a fixed point with one hand against the back of 
the sacrum, and you can pull the limbs backward in this way; that would be 
when the pelvis was tilted backward. Or, you can get the knee in the back, 
and pull back on one side and then on the other with the patient lying upon 
his side as well as to set him in the chair. Some will prefer that method per- 



172 TO SET THE INNOMINATE. 

haps. Then, there is another method; of course there are different ways in 
which you might do this. One of the best ways which I have found to move 
the pelvis with the patient on his back, is to fix the hand and place it under 
the sacro-iliac articulation and then flex the thigh, and pull the knee down, out 
and around quite strongly and thus relax the ligaments of the articulation. 
That should be done upon one side and then upon the other. Our experience 
and practice has taught us this one thing: that ligaments are extremely impor- 
tant; the "Old Doctor" sets considerable store by ligaments. You may have 
such a thing as a cold, and the effect upon the ligaments will be to contract 
them, and you will have dislocations of the parts affected, from that simple 
fact. You may have dislocations of the pelvis or of one of the innominate 
bones. I had quite a remarkable case the other da}- — there was almost com- 
plete paralysis of the lower limbs, there was sensation and some motion, but 
there was very little motion, the patieni went about in a chair. That had all 
been brought on by la grippe, and the whole body had ceased to grow, the arms 
were thin and small, the face and head were normal, and you got the impress- 
ion of looking at a dwarf when you examined the patient. So it is that a cold, 
light or severe, may act upon the ligaments and contract them and thus cause a 
displacement of the parts, and there is no doubt that is frequently the cause of 
displacement of the pelvis as of other parts. 

Now, I have already stated, not only may the whole pelvis move one way 
or the other, but one innominate bone may move one way or the other. That 
is, the whole bone may be slipped up or down or it may be tilted backward or 
forward. However, when the bone is tilted forward, you will see that it al- 
most inevitably goes somewhat upward on account of the shape of the articula- 
tion here with the sacrum. From that fact, since when it is tilted somewLat 
forward, and at the same time has a tendency to slip up along the back part 
of the articulation, it will have the effect of shortening the leg. Consequently 
when the innominate, not the pelvis as a whole, is slipped forward, you might 
have a shortening of the leg. Naturally you would suppose that a slipping 
forward of the pelvis would lengthen the leg, but you can see from what I 
have said that such is not likely to be the fact. Of course that would change 
the normal axis of the parts. The various axes are made by junction of the 
sacrum and ilum by means of ligaments, and when the innominate bone is mov- 
ed in one direction one point will be fixed and act as an axis, and another point 
will be fixed and act as an axis in another position of the innominate bone. 
That subject has not been thoroughly studied out, but it is a fact that when the 
innominate is slipped forward then you have a shortened leg, and when back- 
ward you will probably have a lengthened leg. Dr. Harry is authority for the 
statement that a twisted or tilted innominate may shorten a leg as much as 
three inches. Of course a novice looking at such a condition would think at 
once that the hip was dislocated, and that he had one of those wonderful things 
that are so much talked of, but it is not always the case, and you must be care- 
ful in your examination. One of the first things in examination is to make 



TO SET THK INNOMINATK. 1/3 

these motions of the thigh in and out, flexion of the knee up toward the shoul- 
der, and so on, for the purpose of relaxing all unnatural tension about the leg, 
so that you can tell whether or not the limbs are similar. Then gettting the 
patient straight upon the table which you will have to do by accuracy of your 
eye, you can of course judge whether or not a line drawn between the anterior 
superior spines is at right angles to the direction of the body. Then you will, 
by taking a certain point, preferably the bottom of the heels, or just where the 
seam runs around above the heel, note whether the legs are of the same length. 
Of course you will have to take into consideration any variation in the thick- 
ness of the heel, some people have a thickened heel or sole put on their shoes 
for the very reason that their limb is a little shorter, though quite as frequent- 
ly the condition has not been discovered. When you have pain in the lumbar 
region of the back, pain in the hip, or in the leg, or in the sacral region, or in 
the external genitals, you will do well to examine to see whether or not the 
limbs are of the same length, and if such is not the case you may continue the 
examination further by looking to see whether or not the p'elvis or one of the 
innominates is displaced. When you come to measure one leg by the other 
you have a variable standard, it is hard to tell whether or not one leg is longer 
than it ought to be, or shorter. So you have to take means of determining 
which is the affected side. It is well to go to the sacral articulations, where 
there will be soreness on the side affected, because a greater strain has come 
upon the ligaments there, and you will also have a soreness on the symphysis 
on the side affected. You will frequently have a tension and some tenderness, 
very likely from contraction of muscles, on the opposite side from the one af- 
fected. Taking this left one as the one affected, then you might have a con- 
tracture here and some tenderness on the right side, because when you have 
one thrown out of position, then yon have the equilibrium destroyed; there has 
to be readjustment of the parts, and you will have tension there on that ac- 
count, but I think the rule given you will indicate to you which is the side af- 
fected. 

As to how we may remedy the defect of one innominate being slipped, 
there are various waj^s; some are the same as I have shown 3'ou. As I have 
vSaid, the motion thus employed, by flexing the thigh against the thorax, plac- 
ing the hand firmly under the pelvis, and pushing the knee outward and down, 
thus straightening the leg again, is one of the best methods I have found. After 
you have done that, it is just as well to give the leg a straight pull, not a jerk, 
and you can thus bring tension upon the ligaments, and you can in that way 
frequently straighten mechanically, and I think you can get a certain nervous 
effect that will relax the spasm. It is just like putting your hand upon a con- 
tracture and gently pulling against the contracture until you have relaxed it, 
so it is with the limb, you can relax the spasm of the muscles, you can restore 
the equilibrium of nerve force, and it will return to normal. That is one way; 
another way is for the operator to stand in front with the patient upon the side, 
then, by reaching under the limb and grasping the tuberosity below and the 



174 TREATMENT OF THE BLADDER. 

anterior superior spine above, you can move it in either way very readily; you 
can slip the innominate forward or backward; that is one of the best ways. 
You can in that way stand in front of your patient and do your work. You 
can get behind the patient, use the knee as a fixed point against the sacrum, and 
then, holding against the anterior superior spine, work it backward in that 
way. When you stand behind, the idea is that you can work to draw the an- 
terior spine toward 5^ou. Also you can stand behind the patient, one arm be- 
neath the thigh of the patient, making a fixed point of your hand against the 
sacrum, then bend the leg back until you have it back to a considerable extent, 
varying the degree of tension according to the patient. That is one very good 
way to force the bone forward. Pressure upon the sacrum is very frequently 
employed; it is one of Dr. Hildreth's very common treatments. In a great 
many cases of treatment along the lower part of the spine Dr. Hildreth will 
finish by putting his knee against 'the sacrum and bringing it inward against 
the patient, while he draws the pelvis of the patient back towards him. The 
idea being, as you readily see, to relax the ligaments and to take off the ten- 
sion which is thus brought upon the branches of the sacral plexus. From 
what I have said and from combinations that your own ingenuity will suggest 
to you, you can remedy the defect when the innominate is slipped upward or 
downward. You might set the patient upon a chair and lift upward, at the 
same time having an assistant push downward upon the crest of the innomi- 
nate affected. One point that you might notice in regard to affecting the in- 
nominate is the fact that the quadratus lumborum has a tendency to help mat- 
ters along by its contracture, and in relaxing the tension about the innominates 
ivhen displaced, you would do well to stretch the quadratus lumborum. That 
I have shown before; give it the diagonal stretch this way once or twice and 
•once or twice the other way; you can do that better with an assistant, because 
you can get a better tension. I think this shows the value of steady, firm work 
•over the body. The idea of working with jerks is bad, because as a rule, when 
you give a pull or prCvSsure, the idea is that you are relaxing, it is in the nature 
of inhibition of nerve force, and if you go at it with a jerk, you are not only 
liable to stimulate instead of inhibit, but thus set up a firmer contraction, 
whereas you wish to relax. 

In treating the pelvis, I have already noted the point that you can work 
upon the spine of the ischium, thus impinging directly upon the pudic nerve. 
I have indicated how you should find that point by a line drawn from the pos- 
terior spine of the ilium to the outer side of the tuberosity, the junction of the 
lower with the middle third of the line will be the point where you can best 
impinge upon the pudic nerve, and then by relaxing the glutei muscles by 
drawing the limb backward some, you can get deep pressure at that point, and 
thus stimula*e or bring pressure and inhibition upon the nerve. Of course the 
effect of that is to work upon the perineal branches, and through it to cause 
^contraction of the perineum itself. 

As to the bladder, the point at which we reach the hypogastric plexus^ 



TREATMENT OF THE BI^ADDER. 175 

supplying the fundus of the bladder, is at the fifth lumbar, as you well know. 
And then along the sacral region we get some motor fibers to the bladder. 
Along the lumbar region, according to Quin, we get motor fibers, particularly 
to the circular fibers of the bladder, including the sphincter. He says there^ 
are probably also to aid those fibers, inhibitors to the longitudinal fibers. Thus, 
work along the lumbar region would affect the bladder. An inhibitory effect 
would be to relax those circular fibers, and a stimulating effect would be to con- 
tract the circular fibers. In the sacral region the Osteopath takes as his center, 
the third and fourth sacral, and he works there to relax the spincter of the. 
bladder. It is stated by Howell's Text Book that in that region we get princi- 
pally the nerve fibers to the longitudinal muscular fibers. So you see there is, 
a contradiction between the Osteopath and the text book. However, it has 
been our practice that by working in that region we got the effect, and of 
course when theory and practice conflict we must take practice. There is a 
difference between the text book and what we have found in practice; we cannot 
always make them agree. It is stated by Howell's Text Book that in the 
sacral region and in the lumbar region there are no vaso-motor fibers given off 
to the blood vessels of the bladder. 

It is hardly worth while to tell you how to examine the bladder. Of course 
you know where the bladder is situated; when distended, it will rise above the. 
pubes, and you will likely find it by the tumor, and on percussion you will get 
the flat sound from the contained fluid, so that will be part of your examina- 
tion, but the general symptoms which you will get, 'particularly in your symp- 
tomatology and in urinalysis, will direct you in your examination of the blad- 
der. If you have a case of ammoniacal urine you will be able to recognize the 
crystals under the glass, and can tell whether there is trouble with the bladder 
in that way; you will note the presence of bacteria, setting up a decomposition 
in the urine. Several months ago I examined a sample of urine under the 
glass; it was freshly drawn and it was crowded with bacteria. I directed the 
operator who brought the sample to boil the bottle and let it cool and thus have 
it completely sterilized, and bring me a sample as fresh as possible. He did 
so, and examination showed a great number of bacteria, and that very soon 
after obtaining the urine. This indicated the presence of bacteria in the blad- 
der, setting up a decomposition of the urine. In that instance it was a case of 
bladder instead of kidney trouble, as had been thought. That case had an en- 
larged prostate; the prostate had acted as a partial stricture to the passage of 
urine, and the patient had used a catheter, had not taken any precaution to 
keep it antiseptic, and had thus brought about a large amount of his trouble. 
The operator washed out the bladder with some antiseptic solution and reduced 
the prostate, and the patient was out in a few days. The doctors had had him 
ready to die of kidney trouble, but the trouble was all in the bladder and pros- 
tate. Of course in all our treatments we get particularly an effect upon the 
centers indicated in the spine, viz.: the fifth lumbar and the second lumbar, 
the centers respectively for the hypogastric plexus and micturition. The 



176 TREATMENT OF THE OVARIES. 

treatment there I hardly need to show you; it is the same as I have already 
shown you in how to treat the spine. There is another treatment, though, 
which I have already shown you, the treatment by raising the bladder bodily. 
You can do the same thing by having the patient stand in front of you, bend- 
ing forward at right angle, thus letting the abdominal contents drop down to- 
ward the symphysis, then by deep pressure inward and raising as the patient 
straightens up, you can raise all those parts. I have spoken already of enter- 
optosis, the dropping down of the intestine; I shall speak presently of the pro- 
lapsus of the uterus and all those things that allow a lengthening and a relax- 
ation of the ligaments which bind <-hese abdominal contents to the walls. 
Anything which allows a relaxation, of course brings down those structures, 
and the Osteopath argues that there is too little life there. Now, how does he 
go about to replace those things? Should he simply push them into place, they 
would not stay — they must be held there. Hence, the importance of our work 
along the spine, stimulating the nerve force and life to the omenta which are 
holding these abdominal contents in place, so as to regain their tonicity. 
Never forget that it will not do to replace a prolapsed uterus or replace intes- 
tines which are displaced by reason of enteroptosis, unless at the same time 
you include the work along the spine; that we work with the idea of stimulat- 
ing the life of the ligaments and making them tense again. In fact, we should 
always have that in view, particularly we should be careful to stimulate or in- 
hibit the nerve force to the part in trouble. We would also work deeply in 
this manner here, over the internal iliacs. That is one of the treatments for 
the bladder also. We thus stimulate the blood supply and direct it more par- 
ticularly to the part affected, by reason of the tendency toward the normal, and 
that treatment is very effective in such troubles. Of course in retention of 
urine you wall always suspect some stricture. You may have an enlargement 
of the prostate or some trouble of the sphincter of the bladder. You will find 
also that the quantity of urine varies — af Ler very long reading by a person who 
is not used to reading much, the amount of urine will be increased, and after 
hysteria and various troubles, the amount of urine is greatly increased. There 
is a motion employed largely by Mrs. Patterson for raising both the bladder 
and the uterus. She has the patient flex the thighs, then, directing the pa- 
tient to hold the knees together, you push them apart. In other words, you 
work against the resistance of the fiexed thighs. In that way the psoas mus- 
cles will contract and the idea is that as you push them out the bladder will be 
raised; having done that, you try just the opposite, tell the patient to hold the 
knees apart and you draw them together. Mrs. Patterson employs that method 
of treatment very frequently and has had very good success in female troubles 
in that way. It affects both ^he bladder aud uterus. 

We should next direct our attention to the ovaries. They are found an 
inch and a half in\Nard from the anterior superior spines of the ilia. It is said 
they cannot be examined by physical means, that is, you cannot find them by 
simply feeling over the flesh where they should be, and it is only when tender 



>»•* 



EXAMINATION AND TREATMENT OF PEI.VIC VISCERA. I// 

or when enlarged that you will be able to make out by physical examination 
the location of the ovaries. However, when inflamed, as they very frequently 
are, the intense tenderness there about an inch and a half interior to the anter- 
ior superior spine would indicate their site. Also when inflamed they frequent- 
ly cause a swelling there and you will be able to find their location. The ovary 
is also frequently the seat of a tumor, and the tumor may become very large, 
and then not only palpation, but inspection, will reveal the seat of the trouble. 
Our treatment for the ovaries is through the lumbar region, as you know. The 
centers given by Howell's Text Book for the internal genitals are along the 
lumbar region from the second to the fifth; that is, vaso-motor fibers of both 
kinds run to the internal genital organs. We should also examine carefully 
the sacro-iliao region and the lower dorsal. The center for the blood supply 
for the ovary is between the tenth and eleventh dorsal, and you should look all 
the way from the ninth to the twelfth dorsal particularly to see whether or not 
there is a lesion affecting the ovaries. We work upon the eleventh dorsal, re- 
storing it to normal when it has been misplaced, both is cases of profuse men- 
struation and in scant menstrual flow. That seems to be the particular center 
since it has control of the blood supply to the ovary. Also, as you know, the 
spermatic artery in the male, becoming the ovarian in the female, arises about 
opposite the second lumbar vertebra, that is, a little above the umbilicus, and 
by working in deeply, trying to get as far as possible in under the transverse 
■colon and working on down in the direction of that artery, down as far as the 
ovary, you wull be able to stimulate the blood-flow, and then by working back- 
ward in the same direction you stimulate the venous flow; also working over the 
uterine blood supply, because these vessels anastomose a good deal, and you 
thus stimulate the entire blood supply. Of course the ovaries are closely con- 
cerned with menstruation and it wnll be worth your while to bear in mind that 
they act alternately, one will ovulate one month and then not again until the 
second month. So if you have a trouble recurring every second month you 
will be able to calculate that the trouble is in one ovary or the other, and your 
further examination will indicate to you which is the ovary affected. In cases 
of obesity where the patient is extremely large, cases are on record where the 
accumulation of fat has acted to crowd the ovary, hence the menstrual flow did 
not occur and the ovaries were atrophied. It may act in a mechanical way and 
•separate the Fallopian tube from the ovary so that the Fallopian tube cauuot 
take up the ovum when discharged. So that if you have a case of menstrual 
trouble where the person is extremely large and obese, then you will bear in 
mind that the obese condition itself may have some effect in causing the trou- 
hle. Of course the ovary, as it is situated in the broad ligament, is drawn down 
in any prolapsus of the uterus and will be implicated in many troubles of that 
kind. As for treatment, it is especially along the lumbar region and also at the 
centers designated, the eleventh dorsal, not forgetting the fifth hinibar. which 
is the center for the hypogastric plexus, through which we get the pelvic plex- 
uses which have to do with the life of the ovary. 



178 EXAMINATION AND TREATMENT OF THE PEI^VIC VISCERA. 

Q. In that case of paralysis you spoke of caused by the grippe, what was 
affected? 

A. The whole spinal life was affected. I have seen cases where the 
grippe was the only cause apparently and the whole muscular life along the 
spine was diminished. 

Q. Do you think that can be corrected by treatment? 

A. Yes, sir; I think we can secure good results. 

Q. Does that include the ligaments along the spine? 

A. Yes, sir; that is the main trouble. The ligaments are contracted, shut- 
ting off the nerve force. 



LECTURE XXVII. 

At the last lecture I spoke of the examination and treatment of the pelvic 
viscera. I shall continue that subject today, concluding the examination and 
treatment of the pelvis and its contents, and taking up the Osteopathic treat- 
ment of the limbs; I shall then have gone over the whole body. 

I. Examination and Treatment of the Pelvic \''iscera. — Con- 
tinued. —The next organ for us to consider is the uterus. I might say in pas- 
sing that female diseases are among the most numerous class of cases that we 
handle, and are among those best handled by us. A very large percent of 
your cases will be various female troubles, and you will have very good success 
with them. The examination of the ovaries I spoke of at the last meeting. 
Next to the ovaries the uterus is quite as frequently the seat of tumors as else- 
where. These may occur in any part of the organ, and when these have en- 
larged the organ by their growth, you can by the ordinary methods of examin- 
ation find the trouble. In general, speaking of troubles of the uterus, pro- 
lapsus is very common, anteversion, retroversion; also anteflexion or retro- 
flexion, the bending of the uterus on itself. When the uterus falls, it may fall 
forward and impinge upon the bladder, and thus one of the S5^mptoms will be 
very frequent micturition. It may fall backward and impinge upon the rec- 
tum, and you will have a mechanical cause of constipation; dragging pain in. 
the loins and pain down the limbs. Frequently it is associated with local 
headache, which is generally on top of the head; it may be on the back of the 
head or it may run over to the forehead or to one side, but its peculiarity seems 
to be that it becomes a local headache. There are other symptoms, since the 
uterus becoming displaced will impinge upon other viscera and the plexuses of 
those viscera. You will have sympathetic troubles, such as vomiting, sick 
stomach, and things of that kind. In case of any displacement of the uterils, 
the patient is likely to be very sick at the menstrual period. At such times 
the fact that the organ is down and is thus stopping the flow of the blood, will 
lead to this condition. I have seen very painful cases at the period relieved 
immediately by replacing the uterus. However, that is not usually a good 



TREATMENT OF THE UTERUS. I 79 

plan to pursue at the menstrual period, since the organ then is very tender, and 
handling is liable to irritate it and set up an inflammation or some sort of 
growth, and you must always be extremely careful in local treatments of the 
uterus. There have been some remarkable cases instanced of an enlarged uterus. 
Of course the uterus normally enlarges within physiological limits; it enlarges 
also from tumor. The chief way in which tumor is differentiated from the nor- 
mal enlargement of pregnancy, is that after a certain time you can hear the 
uterine souffle and the the foetal heart beat. Also after the fourth month, 
sometimes before and sometimes later, you will get the movements of the uterus. 
Dr. Smith tells quite an amusing story of a lady who came to term, she was 
perfectly sure that she was ready to be delivered, but he found mereU^ gas in 
the intestines, a peculiar movement of the gas had simulated the movement of 
a foetus, which had been taken for quickening, and the gas in every respect 
simulated pregnancy. I only speak upon these subjects generally, because in 
gynecology and obsteterics, w^hich you will take up later elsewhere, they will 
be treated fully. What I aim to tell you is how the Osteopath treats the uterus. 
In examining the uterus, besides these general symptoms I have given you, a 
local examination will usually remove all doubt. By inserting the finger in 
the vagina you can feel at the upper end of the vagina, the uterus. You know 
how the uterus lies in relation to the passage of the vagina — nearl}- at right 
angles, perhaps not quite. The normal feeling of the cervix is described by 
the *'01d Doctor" to be about as hard as the end of the nose. On account of 
the transverse direction of the os pubes yon can tell whether or not the uterus 
be fallen or twisted. If you find the os, instead of being directed from side to 
side, is turned at an angle, you can judge from that in which direction the 
uterus has been twisted. The most common displacement is said to be down- 
ward and backward and to the left. ^ Frequently you will find a sort of a turn 
associated with this displacement, and the uterus lies down near the left sacro- 
iliac articulation. If the uterus has fallen forward, of course you will find the 
cervix and os projecting backward, and if it has fallen backw^ard, you will have 
the cervix and os projecting forward, and you will be able to judge as to its po- 
sition. That is what the Osteopath ascertains in making examination pervag- 
inam — he looks to see whether or not the uterus is in normal position. 

Of course you know about the eight ligaments of the uterus; the broad lig- 
aments are the most useful. They extend from each side to be attached to the 
pelvis, and when the uterus is displaced to one side you will find a tenderness 
in the broad ligament on the opposite side, readily explained as the tension 
comes upon the ligament of the other side, the weight coming on it as the 
uterus falls from it. That is one way in which we diagnose. Another point 
in examination per vaginam is to note the condition of the vaginal walls. Of 
course in prolapsus the walls have lost their tone; they have part of the duty 
of sustaining the weight of the uterus. When they are full of tone thev will 
help to hold the uterus up, but if they are prolapsed and sunken down they be- 
come flaccid. Frequently you can give great relief in female troubles by siui- 



l8o TREATMENT OF THE UTERUS. 

pl3^ passing the finger up along each side, before and behind and at each side, 
and smoothing out these wrinkles which have gotten into the walls of the va- 
gina. You can also by that treatment stimulate the flow of blood and stimulate 
the local nerve force, and thus lead to more life in the vagina and consequently 
to a better performance of its duty of helping to hold the uterus up. 

You will find such troubles as leucorrhea following the displacement of the 
uterus, since the nutrition is partly cut off from the walls of the vagina, the 
circulation is impeded and the healthy tone does not exist, consequently 3^ou 
have a morbid secretion. 

The normal position of the uterns I suppose is known to you -the broad 
ligament tilts somewhat backward in the pelvis and the uterus is tilted forward 
at the upper part of the vaginal passage, so that you have practically speaking 
a right angle between the walls of the vagina and the uterus, perhaps not quite 
a right angle. Of course the uterus normally does not rise above the brim of 
pelvis. I wish to empha.size what I said the other da}' in regard to prolapsus 
of the uterus and of the intestine, that is, the Osteopath replaces them, but 
does not expect them to stay simply because he has replaced them. You must 
alwa3's couple local treatment with treatment along the spine. I remember a 
ca.se in point — I examined a young lady in Peoria, she had a twist in the gym- 
nasium, she had jumped to catch a cro.ss-bar and had ^iven herself a jerk and a 
twist. Along in the upper lumbar region there was a lesion, I do not remem- 
ber now exactly which vertebrae were displaced, it was, however, of the lum- 
bar vertebrae, there was quite a prominence of one of them. Shortly after the ac- 
cident the young lady was bothered with frequent micturition, and local exam- 
ination later revealed the fact that the uterus was down upon the bladder, 
That case was treated at the abdomen, over the iliacs, and along the spine, par- 
ticularly at the second and fifth lumbar centers, through which you can reach 
the uterus. The case was entirely cured within two months, and she had not 
had local treatment more than a half dozen times. So you see the Osteopath 
does not depend upon simple reposision, he depends largely upon the work of 
stimulating the nerve force and toning up the blood supph' to give tone to these 
ligaments which have lost their tone, and thus hold the parts in place. For 
the purpose of the Osteopath the finger answers as well as anything for an in- 
•strument The first finger is usually inserted, and you can feel the cervix of 
the uterus The idea then is to push upward in such a way that the organ will 
take the pos'tion of being at a right angle to the broad ligament, and it is well 
while your patient is upon the table to insert the finger, reach upward to the 
uterus, then have the patient slip around and stand up and 3'ou can then push 
forward. One of the best ways of replacing the uterus is to have the patient 
take the knee-chest position — kneel with the chest dowui upon the table orbed, 
and then to push the uterus up, and thus allow the intestines to fall down be- 
hind and over the uterus and hold it in place. The "Old Doctor" has invent- 
ed an instrument which is very useful also in reposition. It is a wire, curved 
with a handle. The. finger of the operator is slipped in with the instrument ly- 



TREATMENT OF THK UTKRUS. , l8l 

ing in the opening between the two wires, and then the point of the iustru- 
mentis placed either behind or in front of the os, depending upon the position 
of the organ, whether it has fallen forward or backward. Then with the point 
of the instrument back and the finger in front or vice versa, you can work the 
organ as you wish. Also you can by working upon the abdomen aid to lift the 
parts. I have already shown you how that is done. That is, you raise it with 
the patient upon the back as I have shown you, or with the patient upon the 
side, or standing bent at a right angle, and you, pushing the fingers in deeply 
over the abdomen, raise bodily the contents. It is also a good idea to have the 
patient practice taking the knee and chest position and simply dilating the 
passage, the atmospheric pressure will sometimes be sufficient to cause the 
uterus to take its place; also the motion I showed you at the last meeting, hav- 
ing the patient lie upon the back, flex the thigh, and the operator pushes 
the legs apart while the patient is holding them together, and drawls the legs 
together while the}^ are held apara by the patient. 

Treat especially the centers mentioned, that is, the second, which is the 
blood supply for the uterus, and the fifth, which is the center through which 
we reach the hyogastric plexus, and all along the lumbar and sacral region in 
general, but do not fall into the error of thinking the trouble is always there, 
because the lesion may be above or below the center at which you naturally ex- 
pect to find the trouble. 

I have already mentioned the point that you should stimulate the cocc}"- 
geus muscle through the sacral plexus, and thus cause it to contract and aid in 
raising the contents of the pelvis. You can also stimulate the round ligaments 
which pass over the pubic arch just external to the symphysis; you can find 
them both by the touch and by their sensitiveness, because when you impinge 
upon them you will always have an expression of pain. Stimulation there will 
help to draw up the uterus; all these things help a good deal. Stimulation at 
the second lumbar is used to cause contraction of the longitudinal fibres of the 
uterus, while stimulation of the clitoris and round ligaments is used to cause 
contraction of the circular fibres of the uterus. Consequently, we inhibit over 
the clitoris and round ligaments to cause them to relax and thus relax the 
circular muscular fibres of the uterus. That is one of the most important points 
in Osteopathic obstetrics. 

In young females and in pregnant women it is advised never to give an in- 
ternal treatment. Mrs. Patterson says that remarkably young children are 
sometimes suffering from prolapsus, and mentions a case in which the patient 
was not over two 3^ears old, but the case was entirely cured by external treat- 
ment. Should 3^ou be treating a case for other troubles in which the patient is 
pregnant, carefully avoid the ninth and eleventh dorsal and the second and fifth 
lumbar, in fact, the whole lumbar region. 

Dr. BoUes has mentioned a point to me which is extremely interesting and 
I think extremely important also. In a case in which there had been abortion 
and the mother had kept wasting from the uterus, a discharge of matter and 



1 82 • EXAMINATION AND TREATMENT PER RECTUM, 

flow of blood, he directed her to rub the nipples each morning with vaseline, 
and thus to stimulate as far as possible the normal irritation made by the suck- 
ling child. He was thus acting in accordance with nature, and the discharge 
ceased. In another case he follow^ed the same rule, where the woman was in 
difficulty, the pregnancy was about three months along, and the indications 
were that the foetus had been dead for come days. The nipples were stimula- 
ted, which caused contraction of the uterus, and the woman was delivered of a 
still-born child. There is a ver^^ close connection between the nerves of the 
breast and of the uterus. It is a very good point in flooding — profuse menstu- 
ration or iu flooding after child-birsh, or in post-partum hemorrhage, which is 
a very serious thing, to give a quick jerk at the mons veneris, thus causing 
pain and causing a contraction; that will usually stop the flooding. I knew of 
a case not many months ago in which the flooding was persistent, and lasted, 
for some time. I sent word to the patient to try that treatment I have describ- 
ed and the flooding ceased immediately. Also in case of post-partum hemorr- 
hage the "Old Dotor" says you should simply insert the fingers into the uterus 
and press upward against the fundus. He presses up and inward to smooth 
out any obstruction which may cause the trouble; of course there is some ob- 
struction there which is hindering the proper flow^ of the blood and so causing; 
the hemorrhage, and simph' that pressing up allows the blood vessels to resume 
their normal relations and the hemorrhage to be stopped Of course you un- 
derstand when you come lo treat uterine troubles, it is a subject for the 
specialist, and you will get this subject fully treated in gynecology and obstet- 
rics. I cannot do more than simply mention to you the usual treatment; this 
wnll als^ be the case later in this lecture when I will take up the subject of dis- 
locations, you wall get them more fully in surgery, but I wdll give you the us- 
ual Osteopathic treatment for them. 

In the examination, per rectum, which is frequently resorted to bj' the 
Osteopath, in the female, if 3'ou will at the .same time insert a catheter into the 
urethra you can feel the urethra along the anterior wall of the vagina. Here 
is an important point which I have never heard mentioned except in connec- 
tion with Osteopathic practice. If 3'our vaginal walls are relaxed and have 
fallen in response to a prolapsed uterus, you may very likely get a twist or an 
obstruction of the urethra through the prolapsus of the vaginal walls. There 
have been some cases of that here, and it has been readily cured by smoothing; 
out the vaginal w^alls in the manner I have described and b}' passing a catheter 
up the urethra, simply straightening out the urethal passage. Besides that you 
find in digital exploradon of the rectum the grip of the external sphincter, and 
you will be able to judge, by practice w^hether or not it is normal. Tue nor- 
mal grasp of the external sphincter is extremely powerful, and of course in all 
these internal treatments you should in.^ert the finger only after it has been 
well oiled with vaseline, soapsuds or something of that kind. You will have no 
difficulty in inserting the finger into the rectum; the palm should be turned 
toward the coccyx, and the finger inserted with its palm toward the coccyx, 



TREATMENT OP LIMBS: DISLOCATIONS. 183 

and then may be turned; the patient may be on the left side, or may be stoop- 
ing, bent over the table. You will also in you practice, no doubt, come across 
cases of prolapsed rectum, the gut may be prolapsed and be folded upon itself 
in just the way the vagina prolapses. In Chicago I had a case in which the 
patient came in great pain, there had been a rectal prolapsus, and there was 
great tenesmus— a feeling of wanting to go to stool continually. It was ex- 
tremely painful and the patient was able to walk only with great difficulty. I 
surmised at once that there was a prolapsus, and I inserted the finger and 
crowded the walls of the rectum upward all the way around. I was able to re- 
lieve the case and lie had no trouble for some time afterward. In such a case 
3'ou must adopt the method of treating over the spine to stimulate the 
nerve force and blood supplv to that part, and thus give permanent relief. 

In the male you will find, after inserting the finger for about two inches 
and turning it forward, the prostate gland. It is said by some authorities that 
the prostate gland is almost universally enlarged in men over forty years of 
age. The enlargement of the prostate is frequently the cause of stricture of the 
urethra. You will find the lateral lobes of the gland enlarged, or the central 
lobe may be enlarged. Should the lateral lobes be enlarged there may not be 
much difficulty, but if the central lobe is enlarged you are very apt to have 
stricture of the urethra. All of these internal treatments should be resorted to 
on'y in case of necessity, you should not treat internally very frequently, not 
more than once a week, and sometimes not more than once in two weeks or a 
month. Be very careful in treating internally, as you may irritate the internal 
parts. When the prostate is enlarged it may set up considerable irritation, and 
curing that may be the only way of curing certain genital troubles in the male. 
The prostate is very easily reduced, you can reduce it in a half a dozen treat- 
ments, treating once a week or once in two weeks. 

Q. Is it reduced by local treatment? 

A. By local treatments. Of course you must couple with that treatment 
over the internal iliacs to tone up the blood supply. 

II. Osteopathic Treatment of the Limbs: — In consideration of the 
the arm, the ball and socket joint is the one most likely to be dislocated. First 
I will describe the ways in which this dislocation may occur: The dislocation 
of the humerus may be downward in the axilla, it may be backward upon the 
back of the scapula, or in front under the clavicle, or it may be slightly up- 
ward, called a partial dislocation, against the coracoid process. Now the treat- 
ment for an}' of these is practically the same. One good way adopted by the 
practice is to put the knee under the axilla firmly; of course you would have 
an assistant holding against the patient to exert counter pressure. I would 
then press the arm .-strongly in this way, and thus spread the joint, bringing 
pressure upon the contracted muscles and upon the ligaments, and they will 
draw the bone down into place. Another way is when the patient is lying upon 
the table, simply to place the foot in the axilla in this way, and you can get a 
powerful leverage, as you see, and can force the arm ou*^ into its sockei. I do 



1 84 DISLOCATIONS. 

not know just how frequent the dislocation of the shoulder is in practice, but I 
do know that in gymnasium practice the shoulder is very frequently dislocated 
and set by a move on the rings, without harm. This joint is usually set with- 
out difficulty; of course it must be set very soon after dislocation. 

In dislocation of the elbow, there are five different displacements. Both 
bones may be dislocated backward, both bones may be dislocated internally or 
externally; the ulna maybe dislocated backward, or the radius may be disloca- 
ted forward into the hollow on the front of the humerus, or it may rarely be 
dislocated backward. One method described is to place the knee in the bend 
of the arm and then by having your assistant exert counter traction above the 
elbow, you can spring the arm down strongly in this way. That will do for 
the first three. When you have thus exerted considerable tension, enough to 
overcome the contraction of the muscles, the bones will slip into theii places. 
When the radius is dislocated forward, of course that would diaw the hand 
back, and by turning the hand toward the supine or half supine and ex- 
erting traction downward and outward in such a way as to pull the head of the 
radius down into position, you wall be able to work it into place. 

In dislocations of the v/rist both bones may be out of place, the radius may 
be forward or the ulna backward, and in all those cases simple extension is re- 
quired; 5^ou have you assistant fix the elbow and then you exert powerful trac- 
tion upon the parts until the}' have been drawm into place. 

In dislocation of the fingers it is said dislocation is usuall}' between the 
first and second phalanges, and there, also, simple extension is required, draw- 
ing straight upon the finger until the bone is slipped back into place. Dr. . 
Harr}' Still says, in his own peculiar way, that if a bone is out all you have to 
do is to move it around enough and it will want to slip back into place. 

As to the usual way of treating the arm, you have seen that we frequently 
use it as a lever. In some cases, as for instance in articular rheumatism, we 
work with the idea of spreading the joint and allowing the blood and nerve 
force to be freed about the joint, especially allowing inflow of the blood, the 
stimulation of the blood flow thus removing the deposit in the joint. You can 
readily stretch the joint by doubling the hand and putting it under the axilla 
and then pressing the arm in against the side. That, of course will draw the 
shoulder dowm, and I have had some very good success in relieving cases of ar- 
ticular rheumatism in that way. In spreading the joint you can also stimulate. 
Place your hand upon the front of the elbow and then bend the arm strongl}^ 
over the hand; that will spring the joint; and also by turning it out at a right 
angle, you know^ how the olecranon process catches at the back of the hum- 
erus, by bending the arm at a right angle so that they will not catch, you can 
exert pressure to spread the joint. Also you can stmuliate the flow of blood 
down the arm by a certain twisting motion. That is one of Dr. Hildreth's 
movements. I have hold of the arm and I am moving the head of the humerus 
in the socket. I twist it in that way without exerting much force. I might 
speak here of the fact that you can impinge upon the nerves of the inner side 



TRKATMKNT OF I.O\VER LIMBS. 1 85 

of the arm, the branches of the brachial plexus running down there, and the 
axillary artery. In general if you impinge upon an artery, press it toward the 
bone; do not press it toward the muscle. Ycu will find in your practice that 
these nerves become paralyzed by the use of a crutch, setting up crutch para- 
l^^sis, and that is a point which is w^ell to take into consideration. Also we 
have found in our practice that something will catch here at che anterior part 
of the shoulder; whether it is deltoid fibers under the coracoid process, or 
whether it is a simple binding of the ligaments drawing thehead of thehuraerus 
out against the acromion or coracoid, it is hard to say, but we frequently find 
a catch there which w^e can reduce by drawing the arm upvv^ard and backward, 
and then, when horizontal, draw it outward, and having the fingers in front 
over the process you can free any obstruction in that way. I do not know^ just 
what catches there, but I have seen cases of extremely lame arms which could 
not be raised higher than the head, and could not be put behind the back, re- 
lieved by that treatment. Sometimes you will have such an injur}- as will 
cause a contraction of one of the heads of the biceps muscle: you know its at- 
tachments; by straightening the arm and drawing it backward, thus leugthen- 
ening the distance between ths attachments of that muscle, you bring tension 
upon it. Frequently you w^ill find that muscle contracted, and all 3^ou w^U 
need to do is to stretch it, thus inhibiting its nerve force and thus relaxing its 
spasm, and you get rid of the trouble. 

In the treatment of the legs you have all seen the various motions we all 
go through with, perhaps you have not all appreciated what the purpose of each 
movement was. When I flex the thigh above the thorax and the leg upon the 
thigh I am stretching the quadriceps extensor muscles. You see you simply 
stretch it and with it you free the blood supply, the femoral artery and the an- 
terior veins and the anterior crural neive. That is the purpose of this motion 
which you see so frequently employed. Sometimes, of course, we simply use 
this motion as a leverage, having our hands in the sacro-iliac joints; you know 
its purpose already. You have thus stretched the anterior muscles of the thigh: 
3'OU can stretch the muscles of the anterior part of the leg simply by pushing 
the toe straight down. That is a most frequent motion that the Osteopath 
uses. You can stretch the calf muscles in just the opposite way, by pushing 
the toe in the direction of the knee; and you will have no difhculty in pushing- 
it strongly enough. We can stretch the adductor muscles by holding the leg 
.straight, standing between the legs and separating them. You can stretch the 
external rotators by an internal movement in this way; it is very well to regu- 
late the force in this way: In making this movent turn just enough so that 
the patient turns on the side, it is not necessary to use a great deal of force; 
then turn the other way until you have turned him about the same distance. 
We may also stretch the muscles on the back of the thigh, you know that in 
raising the knee, for instance against the chest, you can only do it by bending 
the leg; if you straighten the leg you can get it to a certain height and then 
you feel tension upon the hamstring muscles, consequently we frequently use 



l86 THE IvIMB AND FOOT. 

that in our practice. Putting the heel over the shoulder of the operator and 
raising the limb higher than it can naturally go. you see it cannot naturally go 
quite to a right angle, you thus lengthen the distance between the points of 
attachment of the muscles on the back of the thigh and you stretch them. Fre- 
quently you will find it important to stretch those muscles. I had a case just 
the other day of this kind, where the legs were drawn with rheumatism, the 
patient had no use of the limbs, they were considerably draw^n, the toes were 
turned in, the muscles set and it was with difficulty that I could handle them.. 
I simply brought deep pressure in Scarpa's triangle on the anterior crural 
nerves, and that relaxed the anterior muscles. I had another case in which 
was paralysis of the lower limb, and frequently the limb would jerk when I 
would treat it, so I inhibited the anterior crural nerve and the limb would relax 
directly. So we pay particular attention to Scarpa's triangle since there we 
can impinge upon the femoral artery and upon the anterior cruraljnerve. Also 
^ve treat in the popliteal space; we very frequently knead it or work its con- 
tents, simply bending the knee, putting the foot of the patient between your 
thighs and working in the popliteal space; you can thus free any contraction 
there, and can stimulate both the popliteal nerves and the blood vessels. 

Frequently in cases of rheumatism you will have trouble with the feet. 
You can straighten them down forward as I have shown, or backward. In 
treating the feet you will see that there are two natural arches one lengthwise 
of the foot and one crosswise of the foot; consequently in your treatment of the 
feet you can break it in two ways — you can spring it down toward the toes, or 
you can work with both hands beneath the instep and spring it toward the 
sides. In doing that the piinciple is that you stretch the ligaments about the 
joints. You can stretch the ligaments at the articulation of the ankle by this 
forward and backward movement and by working it from side to side. By 
breaking the two arches of the foot as I have shown, you can relax all of the 
ligaments across the arch of the instep. Of course the toes can also be treated 
in the same way. We frequently are called to treat for corns along with the 
rest of our treatment, not that anyone pays us $25 for treating their corns, but 
if they have something of that kind the matter with them they always want 
370U to put that in. When 3^ou are treating a toe, you know the vessels run 
down the outside; simply spring it from one side to the other; that will stretch 
the ligaments and the blood vessels and stimulate the nerves. 

Q. Would that treatment cure a cramp in the foot? 

A. It would depend on the cause, if the cause were in the foot it would. 
You could very well cure some cases. 

Q. Would it cure cramps on the bottom of the foot? 

A. It would depend upon where your obstruction was; it might be higher 
in the path very likely. You would have no trouble in curing it in the foot; I 
have found that in my own case, by simply stretching it. Every one naturally 
does that; some people are much troubled by cramping in the feet. 

It frequently becomes the duty of the Osteopath to stretch the sciatic nerve 



DISLOCATIONS OF HIP, KNEE AND ANKLE 1 8/ 

thoroughly by stretching in this way, placing the heel of the patient over oper- 
ator's shoulder, and lengthening the distance along the back of the leg, and 
then since the branches of the nerve run on down over the planter surface of 
the foot simply pull down on the toe and you can stretch the sciatic nerve con- 
siderably, Also, in the treatment of sciatica it is one of the treatments to work 
the limb outward in this manner, thus to relax the muscles throughout the 
whole course of the sciatic nerve, or, by inward turn, the pyriformis and those 
short mucles, the external rotators which may impinge upon the nerve. 

As to dislocations. — Frequently you get a dislocation of the ankle, the 
foot may be thrown outward, in which case 3^ou have an inward dislocation; or 
it may be the reverse, or these bones ma}' be thrown forward upon the ankle, 
in which case you have a forward dislocation. In a few cases you have a 
backward dislocation. The movement is to have your patient lying down, flex 
the knee at a right angle, have your assistant fix the knee so that he can exert 
counter-extension, then you simply stretch and bend the foot in the direction 
in which it would go. If it was thrown outward stretch it and bend it inward, 
and vice versa. We do this in the case of the toes, simple extension is the 
method employed. In the case of the knee the dislocations also are four; in- 
ward or outward, forward or backward. It is said simple extension is enough. 
However, the Osteopath uses this movement: he flexes the knee at a right 
angle, and then reaching in at the popliteal space he grasps both the internal 
and external hamstring tendons and pulls outward with the idea of spreading 
them, drawing them away from the prominences at the end of the femur; and 
then he pulls with considerable tension and attemps to spring the joint back 
into place. 

Dislocation of the knee is rather serious as it is especially apt to be fol- 
lowed by inflammation. 

As to the hip. There are four dislocations described for the hip. One 
is upward and backward upon the dorsum of the ilium, in which case the leg 
is shortened and the toes are turned inward. Another is backward into the 
sciatic notch in which case also the limb is shortened, though not so much, 
and the toes are turned inward. The third is forward into the obturator fora- 
men and is called the thyroid dislocation. It is the most difficult with which 
we have to deal, and when such is the case the knee is bent, the toes point to 
the ground and may rotate inward or outward; and in the other case the head 
of the femur if forward upon the pubic arch and the turn of toes is invariably 
outward. So you have two in which it is always inward, one in which it may 
be inward or outward, and one in which it is invariably outward. Of 
course, dislocations when they are new are fairly easy to reduce, but 
the Osteopath gets them almost always when they are old. Your treat- 
ment must first be directed to softening all the ligaments and the muscles, re- 
moving the unnatural tension, and thus get the hip ready to set. These old 
cases are almost always slow to set, though I have seen some long standing- 
cases set in a few treatments. You always have two factors of great aid t 



1 88 DISLOCATION OF THE HIP. 

5'ou, one is the anterior "V" ligament of the hip joint and the other is the 
action of the small muscles, the pyriformis, obturator internus and externus, 
the two gemelli, and the quadratus femoris. They are attached in such a way 
as to draw on the great trochanter. When it is up, they are below, conse- 
quently the}^ are of great importance to us in setting a hip. If the hip is up 
and back, you simply flex the thigh still more, turn it inward strongly until 
you get the tension of those muscles, and then throw it outward, and get the 
head of the femur to travel just over the edge of the ascetabulum. That looks 
ver}^ easy, but I will assure you it is not. When it is dislocated backw^ard into 
the sciatic notch, the idea is to flex the thigh, work the knee inward to dis- 
engage the head of the femur from the notch, and then work it upward and 
forward iti this way, and 3^ou get the head of the femur drawn toward the as- 
cetabulum. When the dislocation is forward into the obturator foramen you 
are usually in difficulty. The motion described for that is to flex the knee and 
to rotate it inward, using the attachment of the "Y" ligament as a fulcrum 
against which the limb works. Flex the thigh and work the head of the femur 
inward or toward the cot^'loid notch. In the fourth dislocation, where the head 
of the femur is over the brim of the pelvis, considerable tension is exerted 
backward, long enough to stretch these ligaments, and then try to lift the head 
of the femur over and across. 

In diagnosing the hip dislocations you frequently find it very difficult. If 
3^our dislocation is backward into the sciatic notch, your limb will be a little 
shorter, the toes wiil be turned in, and when the patient sits up you have a 
shorter limb. While if it is forward it always lengthens the limb for the pa- 
tient to sit up. Of course, as I have said, the hips get out and stay out for a 
great length of <"ime, and we have a great deal of trouble in getting them back, 
and I believe of all the hard dislocations, the most difficult to treat is the one 
into the obturator. 



LECTURE XXVIII. 

There are two or three points to which I neglected to call your attention 
at the last time. I mentioned treating the prostate gland, but did not show 
3^ou how to treat it. You know how to find the gland, and working down 
across it on each side with a fairly firm pressure, just to stimulate the flow 
of blood through it, is the motion employed. 

Also as to the saphenous orening, we treat that by stretching the thigh 
which has been flexed outward; that wnll enable you to stretch the muscles 
about that opening, then by rotating the limb inward and relaxing the muscles, 
you can work your fingers in at the opening, you stretch the muscles about it 
and free the opening. 

Tenesmus in the lower bowel occurs frequently in diarrhea and in other 
troubles. This can be relieved by working over the sacrum, especially over 



QUESTIONS. 189- 

the muscles to stimulate and thus cause a contraction of the sphincter and a re- 
lief of the feeling of tenesmus. 

Frequently after parturition the disease known as mi?k leg, or phlegmasia 
dolens, occurs, and is probably due to a contraction of some of the short mus- 
cles, probably the pyriformis; it sometimes happens that the hip has been 
thrown out in the efforts of parturition. Always after attending such a case 
the hip should be turned to see that it is properly In place, and see that the 
muscles are properly stretched. The saphenous veins should be treated also. 
Q. How would you treat for fainting? 

A. By the common methods employed — anything to lower the head; some 
people, for instance, when they know they are going to faint, as some do, will 
drop over the back of a chair, with the head down, and that will stop it. When 
such has occurred, get the head of the patient lower than the feet, you can 
^hen have him hang his head over the end of the table at the foot; or you may 
shock him, pull the hair, or a simple slap will draw the blood to the head w^hen 
it is exhausted. 

Q. I have a case in mind in which bleeding of the nose occurred and 
lasted four or five hours before it was stopped, and the patient finally died. 
What would be the treatment? 

A. To check epistaxis or bleeding from the nose we work in the superior 
cervical region, stimulating; that is frequentl}" of use. Or you may hold the 
facial artery where it crosses the angle of the jaw, or hold the nasal branches 
just here at the inner canthus of the eye. Hold them strongly. That 
is the usual treatment, particularly the stimulation in the cervical region. 

Q. In case of a lady whose babe is about fifteen months old; since the 
birth of her child she has had an extremely sore mouth, the condition of the 
alimentary canal has been such that she could eat but a very light diet; 
diarrhea all the time, and a gradual wasting away of her strength and muscu- 
lar system until she is almost a skeleton. What could be done Osteopathic- 
ally? 

A. What we would describe as a general treatment should be given; a 
general spinal treatment to tone up the nervous system particularly, reaching 
especially the centers for the bowels, the splanchnics, and reaching also the 
kidneys and the liver, toning up the secretory and excretory organs, and keep- 
ing the system in as good a condition as possible. 

Q. It is the disease known among the medical profession as nurse's sore 
mouth: there is also uterine trouble. 

A. You have to look after that also. The trouble is probably of nervous 
origin. 

Q. In the case of a person taking a hard cold, or the disease known a.s 
lagrippe. how would you treat? 

A. I would give a strong stimulating treatment. That is a thing that is 
very important. I have already spoken of the effects of lagrippe several times,.' 
and I have found the most serious results following it after a long period of 



I90 QUESTIONS. 

time. Have the patient on the face for the first. This treatment will also ap- 
ply to what is called a bad cold. I have had some excellent results in treat- 
ing bad colds, and you can usually cure them. Use this general treatment. 
You know the purpose of the treatment — to relax first all the muscles. With 
the condition brought about by lagrippe there is usually a painful aching in 
the back, especially along the lumbar region. I then have the patient on the 
side, and having loosened the muscles as shown, I would spring the spine all 
along b}^ working underneath; you know the various motions. You can separ- 
ate the pelvis and the shoulder by putting your two arms between them and 
springing the spine. Then for this backache in the lumbar region, 1 would 
go particularly to the fifth lumbar, having first loosened all along the lumbar 
region and springing the spine in the good old Osteopathic way. The ache 
there is probably caused by the tension of the ligaments, and while we usually 
use an inhibiting motion to free one from an ache or pain, it depends upon what 
it is caused by. If it it is caused by the contraction, as it probably is in such a 
case, the relaxation of the ligaments should do the work. I would then treat 
for the kidneys with the patient on the back; reach underneath and stimulate 
along the region of the lower splanchnics and upper lumbar. I would also in 
that case treat the liver and the bowels. Give the neck a thorough treatment; 
I have already explained all these things in detail in going over the parts of 
the body. Of course the neck is a part of the spine, and you must be particu- 
lar in watching there to see that this contracture of the deep muscles does not 
affect important nerves, as it may very readily do. Use the motions given; 
first relax all the muscles, then work deeper and spring the neck to relax the 
ligaments. Of course you can work from side to side in this way, and before 
■completing the operation I would give the straight pull as you see here, and 
the bend of the neck, enough to raise the patient's head and shoulders from 
the table. That motion, of course, will stretch all the spine. Then I would 
free all about the head and face, the points of the fifth nerve, those places at 
which you know how to reach it. I would free all of the parts about the face. 
To free the nose press firmly upon the forehead, spring the jaw down, and 
work thoroughly at the styloid processes. It would not hurt to work the arms 
and lower limbs, in fact, go all over the system to loosen any structure, either 
muscle or ligament, which may be contracted by the effects of lagrippe. 

Q. What would you consider a few of the most essential points in con- 
sideration when a patient first comes to see you? 

A. That is a very good question, I think, because it involves the ques- 
tion of how to start about an examination. I would first take the pulse; it is my 
habit to do so, I do not know that it is necessary always; others, I believe, do 
not do it, but the pulse is always considered an indication in diseases. I would 
then go to the spine and examine it thoroughly, but of course I would be 
■questioning them as I went concerning all the symptoms. In fact, before tak- 
ing the pulse I would ask them all about the trouble; I would get the subjec- 
tive symptoms. 



QUESTIONS. 191 

Q. Do you think the history of the case is essential, then? 

A. Yes, sir, it is. 

Q. Please give the treatment for goitre. 

A. P'or goitre we would give essentially neck treatment; I will not 
need to show it to you. Frequenlly goitre is caused b}^ an obstruction of 
veins, However, I think it is often caused by some impingement upon the nerves 
supplying the arteries and veins, consequently you have an obstruction there. 
The idea would be to thoroughly relax all the muscles and ligaments about the 
neck, give the neck the straight pull and the turn from side to side, and bend 
it backward, since there are anterior muscles in the neck which you must take 
into consideration. Sometimes it is those muscles which are contracted and 
are pressing down upon the nerves and vessels. If it is a hard, encased goitre 
with a fibrous capsule, it is very difficult to cure. If it is an ex-ophthalmic 
goitre you will have difficulty in curing it, but the ordinary goitre is dealt with 
with considerable success, although it frequently takes considerable time. In 
treating for goitre I would also, besides the general treatment, work locally 
over the thyroid gland, which you know is the gland enlarged in goitre, work 
across it from side to side, to free the veins there. 

Q. How would you treat enlarged parotid, submaxillary or sublingual 
glands, exceedingly large ones? 

A. Do you know what caused it? 

Q. Not unless it was scrofula. 

A. I should give the treatment for the general system first; we must 
get rid of what is causing it, whether it be impurities in the blood or a scrofu- 
lous conditioD, or anything of that kind. Any case would depend upon gen- 
eral causes to some extent, and you would have to give a general treatment la 
purify the blood. That is, attend to all the avenues of secretion and excretion 
and of assimilation and nutrition in general. The local treatment would then 
be confined to loosening all the parts and freeing the blond and nerve supply to 
the organs affected. 

Q. Please give the treatment for reduction of fevers. 

A. In the first place it is said that when there is fever in the body that 
it is made by the refuse not being cast off, and hence being burned. Nature is 
making an extra effort to burn the refuse, and hence is causing fever. Whether 
that be true or not, you know that there is, in many cases, almost a complete 
suppression of urine in fever, or if not so much as that, that the urine is scanty 
and high colored. You must go to the kidneys and free their action. Go al- 
so to the bowels and free their action; combine the general treatment. Look 
for the cause; of course it would depend upon what kind of fever it was; and 
then having treated the particular cause, the Osteopath also goes to the super- 
ior cervical ganglion, and inhibits the action of the heart. You can inhibit 
the superior cervical ganglion either opposite the transverse processes or in the 
sub-occipital fossae. Then give the treat aieut in the upper dorsal region, stim- 
ulating the action of the lungs to help them to carry oft' the poisonotis matter 



192 QUESTIONS. 

in the bod}'. Also treat the splanchnics. In general, go to the cause. I sup- 
pose you have heard Dr. Still's theory of fever — he says that the lung is not 
acting properly, that the gases are not properly condensed, and he treats fevers 
through the lung a good deal, to get it to act properly that the poisons of the 
bod}^ may be excreted properly. 

Q. Would 3'ou treat the vagi in fever? 

A. Yes, sir, we would treat them for the general effect on the liver and 
intestines, and you could stimulate them to inhibit the pulse. Of course you 
have not cured the fever simply by slowing the heart, that is an adjuvant. You 
must go to the first cause; having done that work I should also go to the 
splanchnics, as I have said, and should inhibit there; having inhibited the cer- 
vical, I would inhibit in the middle dorsal region or along the splanchnics and 
then I would go to the fifth lumbar, where j'ou get the center for the hypogas- 
tric plexus and through it the pelvic plexuses. Your object in doing that is to 
dilate the vessels; inhibit the vasoconstrictors and stimulate the vaso-dilators, 
or you tend to restore things to the normal. In other words, you free the parts 
•affected, and dilate the abdominal veins. In that way you equalize the circu- 
lation. That is just part of your general work, and it depends on the kind of 
fever; in typhoid fever you have to go to the intestines and treat them. 

Q. How do you treat chills? 

A. Stimulate the heart to propel the blood faster; stimulate the lungs so 
that the blood will be better purified and warmed. 

Q. Where the fever follows the chill as soon as it is over, would you be- 
o-iu treatment for the fever at once? 

A. If I supposed it would come on ri,2:ht awav; I would be on the watch 
for it; I do not know that I would begin to treat immediately. But having 
taken those general points together, I would also combine with that general 
spinal treatment and treatment for the heart, a general stimulating treatment, 
and in some cases it might not hurt to stretch the limbs, and do all j^ou can to 
stimulate the flow of blood through the bod3\ In chills and fever treat especi- 
ally the liver and spleen. 

O. Just about what you would do for a cold or la grippe? 

A. Largely so in that general treatment. Then the}' say that rapid rub- 
bing upward along the spine, hard and quickly, will cause a chill to cease. On 
one of the hot days last summer I was called to a case; it was not a regular 
chill, but the person had become over-heated, and the blood had left the surface 
of the body. He felt extremely faint, had difficulty in standing up, and was 
■covered with a cold, clammy perspiration; the surface of the body was chilly. 
I immediately stimulated the heart and lungs, inhibited at the superior cervical, 
and gave a general treatment to equalize the blood and keep it circulating. I 
had the patient keep quiet and he soon felt all right. 

O. I would like to know what treatment you would give for vaso- dilator 
-effect and for vaso-constrictor effect, to inhibit the flow of blood or increase it? 

A. I do not kno^' that I would give any in that way. P"or instance, go 



QUESTIONS. 193 

to the splaiichuics, they contain both vaso-dilators and vaso-constrictors; go to 
the sciatics, the}^ also contain both. Now, I cannot treat the sciatic or the 
splanchnics and cause ttat particular set of fibers to act alone, that is, I do not 
Icnow that I can, and frequently I employ a method which I say will inhibit 
and frequently do that which we say will stimulate, and no doubt we do so. It 
is very hard to say just what we do there, I tend more and more to the belief 
that we simply restore something that is abnormal to the normal conditions, 
and allow nature to do the rest. I think that is the best theory by which we 
can explain so msny things, and there are many things we cannot explain by 
the theor}^ of stimulation and inhibition. 

O- If a person faints from overheating, is not there any special treatment 
besides holding the head down. Dr. Charley Still seems to have had good 
results in that trouble? 

A. In such a case you would also have to direct your attention to the gen- 
eral condition. In case of overheating, where there is an inward congestion, 
very likely the blood is prevented from flowing to the head and is congested 
about the lungs particularly, and about the intestines, since there the veins di- 
late the most readily and hold the most blood. You would have to appl)^ your 
-stimulating treatment, and cause the blood to circulate freely. 

Q. I would like to know why it is that nervous prostration is so much 
more a general complaint of ladies than gentlemen, and what treatment 3^ou 
would advise? 

A. Nervous prostration is a very serious thing. Whenever I can, I ad- 
vise against studying too hard and too long at a time, according to the patient's 
constitution, of course. A person can stand only a certain amount of work at 
a time. For myself I make it a rule not tc> work extremely hard longer than 
two or three hours at a time. I can work four hours or more at a time, but I 
do not do it often. In my regular work where I can regulate my hours, I will 
have something to break in at the end of about two hours. It is a question of 
personal experience and personal taste, although one may work too long and 
too hard. I have seen a number of cases of nervous break down from over 
study. I have seen them in college, and I do not want any in mine. It is caused 
'by lack of exercise, lack of fresh air, sedentary habits, too much stimulants, as 
tea or coffee, and too much of a strain on the mental faculties. To prevent 
that, the prophylactic treatment would be to regulate the habits of the patient 
as far as possible, get them to take plenty of exercise, etc., because when the 
trouble has once come on, it is in the majority of cases hard to get over, and 
almost always leaves its effects. And then as to our Osteopathic treatment, 
the treatment will have to be general, since the nervous organism is exhausted, 
you will have to generally tone it up, and it will take considerable time and 
general treatment. 

O. Give us a treatment for diphtheria. 

A. Diphtheria, of course, is a constitutional trouble. You will have to 
prevent the membrane forming if possible, and that can be done very nicelv. 



194 QUESTIONS. 

Dr. Charley Still has had the very best experience; more than any other Osteo- 
path. He had a remarkable run of cases in Red Wing, Minnesota, and had 
remarkable success. His treatment was vt.ry largely about the neck and 
throat; he would treat there to keep the blood supply open; you know how to 
do it, free all the muscles and ligaments, and especially keep the anterior 
muscles softened and loose so that there can be no tension there or stoppage of 
the blood so that an excretion can grow in the throat and form a membrane. 
You must attend to the bowels and the kidneys and the general health. 

Q. When the membrane does form, what do you do? 

A. Cause the patient to vomit is one way, in order to throw it out, and 
there are certain drinks that they use to loosen the membrane. 

Q. How often should you treat in diphtheria? 

A. Dr. Charley Still said that he frequently would come back to a case 
inside of fifteen or twenty minutes. He was unprotected by the law and he 
had to go very carefully, or he would have had trouble. 

Q. Did he treat for the fever? 

A. Yes, you would have to treat for that according to the treatment out- 
lined. 

Q. In any acute trouble of that kind would you just treat for the symp- 
toms you see, unless you find some lesion? 

A. No, sir, that is hardly our method, you should try to find a lesion, in 
the spine particularly, and you would probably be successful. 

Q. Suppose you did not find a lesion? 

A. If you didn't find a lesion you could only go according to principles 
and word on the centers indicated, but j^ou will find lesions, contracted mus- 
cles, or something of that kind. 

Q. Give the treatment for granulated eyelids. 

A. In granulated eyelids, first, of course, you must turn back the lids 
and examine whether or not the granulations be there. Usually there is con- 
siderable scratching and irritation, and the eyeball is inflamed, then you will 
see the granulations existing as little white points all along on the inside of 
the lid. You may find them on both lids. Our treatment there locally is, 
after having wet the finger with a little soap suds or vaseline, to gently work 
all along under the edge of both lids and to rub on the outside of the lids as 
yon ^o along; that will crush the granulations. Some say that the granula- 
tions are caused by the stoppage of the ducts of the Meibomian glands. The 
"Old Doctor," however, says that there is some obstruction to the veins, that 
the blood is brought to the eye and cannot get away, consequently it must do 
vsomething, and it goes to work to build up some foreign growth. That seems 
to be the most reasonable theory. If you want to know particularly about 
granulated eyelids, ask Dr. Hildreth; he had quite a remarkable case, which 
the "Old Doctor" cured. Having treated the granulations, treat the points of 
the fifth nerve over the eye here, on the forehead, at the inner and outer can- 



QUESTIONS. 195 

thus of the eye, and at the supra and infraorbital foramina, to free the blood 
flow. Treat particularly through the upper cervical region, and look for any 
lesion in the cervical region; give the general treatment for the neck in order 
to keep the blood supply freely open to the eye. 

Q. Where the upper lid is drooping, would you give the same treatment? 

A. I would there stimulate the flow of blood and would stimulate the 
fifth nerve, since it is the muscular trouble, and you must tone up the muscles 
and strive to get them built up through the blood flow. 

Q, Do you give the same treatment for cataract? 

A. You would treat particularly through the flfth nerve for cataract, as 
the fifth nerve has to do with nutrition of the eye, especially its anterior part. 
You reach it through the superior cervical, at the inferior maxillary articula- 
tion, and through these points that I have mentioned over the face. Also look 
for any lesion in the cervical region or in the upper dorsal. Give the general 
treatment of the neck. 

Q. In case of the e3^eball turning inward, for instance the right one, 
through weakness of either the external muscles or increased strength of the 
other muscles, what do you do? 

A. I do not know just what the experience has been in regard to crossed 
eyes. However, I have known of cases being treated surgically, which is 
always to cut a few fibers of the muscle which is opposite to the one affecting 
the eye most — on the side pulling the most strongly; that weakens that muscle 
and allows its antagonist to be more evenly balanced in its action. That will 
allow^ the eye to become straight. But the trouble with that operation is that 
after the person has gotten well and the general health has increased, this 
weak muscle, if the trouble was of this muscle, will strengthen and pull too 
hard against the one which has been weakened by the operation. I have 
heard of such cases. In speaking of such troubles once before I asked Dr. 
Sheehan if he had met such cases and he said he had, where the cure was only 
temporary from that surgical operation, and the trouble returned. The treat- 
ment there Osteopathically would be to strengthen the muscles. I have heard 
of a number of cases being treated. However, in cases of young children, I 
think they are successful. 

Q. This is a case of a party about middle age and it came on suddenly. 

A. I would by all means try it in all such cases: where it comes on sud- 
denly that way it may be a nervous trouble, it may be a slip in the neck some- 
where. I would not send the patient awa}^ and say I could not cure him, not 
unless I was positive. It is pretty hard to be certain. In some cases the 
Osteopath can not tell until he has tried, and if he is conscientious he nuist 
treat his patients awhile before he is sure. 

Q. How would you treat for pneumonia? 

A. In pneumonia the trouble is in the lungs, and pneumonia is usually 
handled very nicely. The patient will usually have fever besides the trouble 
of the lungs. The simple Osteopathic treatment is to stimulate the lungs, as I 



196 QUESTIONS. 

hav^ shown, in the uppei dorsal region all along on both sides. Find out 
particularly which one is affected by the methods which I have shown you. 
Treat for the fever. In children and old people it often follows measles oris a 
complication of them, and if you are called to a case of measles do not forget 
that complication; in all cases look out for p aeumonia. 

Q. Is there any way in which severe coughing can be stopped imme- 
diately? 

A. It will depend upon the cause of the trouble. If I were called to 
such a case about the first thing I would do would be to examine the"pneu- 
mogastrics to see whether or not there was some irritation in the neck affect- 
ing them. Or if I could not find it I would inhibit the action of the pneumo- 
gastrics. There are laryngeal branches supplying the larynx which may be 
irritated, causing severe coughing. It may be some irritation of the pneu- 
mog^stric in the stomach that is irritating the nerves and causing the 
coughing;. 

Q. What would \'Ou do when it is caused from the lungs? 

A. I would give a general treatment to the lungs. I would go to the 
lungs first and treat them. 

O. In case the heart ceases to beat for a short time, say during sleep, 
and the person awakens and cannot breathe until he has got on his feet 
what would you do? 

A. I would raise the ribs on the left side. I would draw the arm back 
stronglv while holding m\- other hand in a \' shape under the angles of the 
ribs. What you describe is probably palpitation, and may be nervous in 
origin. Perhaps the patient has lain upon the back for a certain length of 
time and has turned in his sleep and gotten two ribs pressed together. The 
idea there is that }'ou give the heart more room mechanicall}', b}' raising 
the ribs, and that you stimulate the s}'mpathetics along the spine which we 
reach along the upper dorsal. 

0. Give the treatment for rheumatism. 

A. There are several kinds of rheumatism. In any case we go to the 
kidnevs, we treat them alwa)'s in the manner shown, to free the s\'Stem of 
the acid which is present in case of rheumatism. Sometimes acute rheuma- 
tism comes on without an\- other pre\-ious form, that is, it begins as articu- 
lar rheumatism, and will strike one joint, sa\' the shoulder, and next it will 
be ill the knee of the opposite side, the following day it will be in the fore- 
arm, then in the wrist, and it jumps about from place to place. In such a 
case we would stretch the joint; separate it. I would also, for this shoulder, 
work along the dorsal region, loosening the mscleus there; any contraction; 
then I would stimulate at the origin of the brachial plexus, along the scaleni 
muscles, between which the branches of the plexus run out to the arm; raise 
the clavicle, stimulate the subclavian artery, and in general, thoroughly 
relax everything about that arm an freed the forces of life to it. I would do 
that fo:' ''.ny joint affected. In case of muscular rheumatism you must treat 



QUESTIONS. 197 

very gently, treat the blood and nerve supply to the part and work over the 
muscles affected very gently, that is, bring gentle pressure and stretch them 
very gently. I have known of a case of general muscular rheumatism where 
we simply went over the patient, gave him a gentle treatment, stretched the 
muscles and the ligaments, and stimulated the kidneys and the liver and the 
general excretory organs. 

O. What is the treatment for flux? 

A. The same as for diarrhea. I believe I showed that at one time. 
The chief thing which we do is to work strongly along the lumbar region, 
spring the spine strongl}', and hold against it. I have seen cases treated in 
that way, just as you see me doing here, the point of the knees against you 
here, and hold against the eleventh and twelfth ribs, inhibiting the action of 
the nerves there to stop the rapid peristalsis. That is the theory. You can 
do that by setting the patient up in a chair, get your knee against the heads 
of the eleventh and twelfth ribs, and pull the arms up and out, and }'ou thus 
get a strong pressure against this point. I would also stimulate the flow of 
bile. I described to you not long ago a case of flux of long standing; in 
that case I found that the two lower ribs were too close together on each 
side, and that there was a contraction and smoothness along the lower lum- 
bar region. I relaxed that and staightened the ribs, and it took but two 
treatments to cure the case. 

Q. Please give the treatment fur catarrh. 

A. That is general treatment of the neck, and is what I have already 
given, but I might mention a few points. They say always that there is a ten- 
der place under the angle of the jaw. It will hardly be necessary for me to 
show you all these motions. The theory there is that some contraction, either 
recent or of long standing, is shutting off the blood supply to the membranes 
of the throat and nose. 

Q. Do you treat in the mouth? 

A. We sometimes treat through the mouth. You can pat the finger back 
and work from the top of the palate down along the pillars of the fauces on 
each side; we sometimes do that. 

Q. How would you treat a sprained ankle or knee? 

A. Say it was the knee, you must be very careful, if it is a recent case 
and there is a swelling about it you must take the swelling down. I would not 
move the member much at first, and the best way that I know to reduce a con- 
gested condition from inflammation after severe strain is the use of hot water, 
hot bandages or the hot water bottle, or something of that kind. After having 
reduced the swelling you can see if the parts are dislocated, examine to see if 
they are out of place or if there is any break. Of course if vou are called at 
once to the case you can find that out at once. You should always do that at 
early as possible, find out if there are any dislocated parts, and if there are you 
must Dut them back as soon as possible. If there are no broken or dislocated 
parts, after having taken down the swelling principally by the use of hot ap- 



198 OrESTIONS. 

plications, I would work gently at the popliteal space to relax the muscles and", 
stimulaie the popliteal vessels, then I would bend the thigh up aud stretch the 
muscles about the saphenous opening to allow the blood flow above to be prop- 
erly opened, and give the stretching motion to the leg to relax its muscles in 
general. I should then treat along the lower part of the spine, especially 
where we reach the sacral plexus, so as to stimulate the nerves to the leg. 
Q. Those movements would be rather painful, would they not? 
A. You will have to be very careful, perhaps you cannot do them at first: 
I have had cases of sprain where I would not manipulate at all for several days; 
I just used the hot applications about it, and watched 10 see that no trouble 
took place, but it was several days before T began to manipulate. At first you 
can treat the lower part of the spine without moving the leg, and I would do 
that. In these cases I have had good success Sometimes your strain will 
not be painful, and 3'ou can manipulate the leg from the start; it depends al- 
together on conditions. 

Q. Has Osteopathy come in contact with yellow fever or cholera, and if" 
so, with what success? 

A. The "Old Doctor says he ha^^ treated cholera. I do not know that 
we have ever had any cases of yellow fever. About all I know about the 
treatment for cholera is that Dr. Still says he treated the lungs, he was speak- 
ing on that the other day in relation to his theory of for .nation of gases in the- 
lungs. He also stimulated the excretions. 

Q. What is the treatment in Bright's disease. 

A. In Bright's disease treat for the kidney. Bri,2:ht"s disease is a gener- 
al name. However, it refers to a disease of the parenchyma of the kidney, and 
there are various forms. You would have to look for any lesion affecting the 
kidney along the lower dorsal region or at the second lumbar, and your idea 
there would be to work upon the nerve supply o the kidney by treating over 
the spine. Then you could work at the umbilicus, as I have shown you, to 
to get these centers, or you can reach them by deep pre.'^^sure over the renal 
ganglia, which lie on the renal arteries. 

How do you regulate the action of the kidneys whep they are acting too 
frequently? 

A. When the kidneys are acting excessively or too frequently, t±ie idea 
is that you must find any lesion which may cause an irritation or inhibition of 
the nerve force. It is frequentl3" confined to about what I have said, to lock- 
for the lesion and remove it, and then treat along the region of the spine where 
we get the nerves to the kidne^^s. 

Q. Stimulate to increase the action, and inhibit to lesson it? 
A. Well, that brings us back to the question of just what we do when 
we stimulate or inhibit. It would depend upon the condition there whether 
I would spring the spine and work in such a wa}- as to stimulate or whether L 
would hold. 



QUESTIONS. 199 

Q. If there was too much secretion, you would not treat in the same way 
-as if you wanted to increase it? 

A. I would be very likely to. I would work along the region of the spine 
which shows there is some obstruction to the nerve force and my idea would 
be to remove that obstruction. 

Q. Would you pull on the neck when it is turned to one side or the other, 
and turn it? 

A. I would not pull it and turn it. 

Q. I mean after it is turned? 

A. O, yes; I would not be afraid to do that. I would have the neck 
turned about in this way, and this straight pull is about the best way, but I 
would not pull it and turn it, because you are likely to cause trouble. The 
parts are more apt to be stretched, and you may get an articular process out of 
place. 

Q. In varicose veins, what would you do other than manipulate the 
nerves and the limbs? 

A. I would work along the lower region of the spine and stimulate 
the sacral nerves, and 1 would stretch the leg thoroughly to stimulate the 
sciatic, since the sciatic contains the vaso-motor nerves for the limbs; then 
at t!he saphenous opening, I would loosen that as I have already told you 
how to do, and I would work upward from the varicose veins along the 
•course of the veins to stimulate the flow of blood. Do everything to build 
up the tone of the limb. The trouble may be somewhere else, but it is most 
frequently in the legs, from standing on the feet too much. 

Q. How would you treat neuralgia of the heart? 

A. I would confine myself there to the upper dorsal region. I 
would goto that region first and would give the heart all the room to pla}- 
in that it needed, then I would inhibit at the superior cervical region with 
the idea of inhibiting the nerve force and quieting the spasm if possible. 
You can do anything to reach the nerve force and quiet it. It is evidently 
excited and there is evidently some irritation. Your idea is to find the 
cause of the irritation and remove it if possible. It may be caused b\' some 
poison in the system, then you would have to remove the original cause b\' 
general treatment. Dr. McConnell says the trouble is frequently in the 
costal cartilages. 

Q. How would you treat cerebral troubles? 

A. Through the neck, it depends upon the case, of course. 

O. In hay fever would the treatment be anything different from 
that for general fevers? 

A. Yes, look for the lesion in the superior cervical region or in the 
upper dorsal, sometimes the first rib is at fault, sometimes the clavicle, and 
you must look for the lesion in those places. We do not have the ordinarx 
symptoms of fever in hay fever, it is a catarrh. 

^Q. How would you treat for lumbago? 



200 QUESTIONS. 

A. I would relax everything along the spine, especially in the lower 
part; first by working the muscles, then by flexing the knees against me,, 
then I would put the patient into a chair and lift up and turn as I lifted. I 
think the theory is that the tension of the ligaments there is affecting the 
nerves and causing the stiffness of the muscles. I have seen several cases 
treated in that way and very successfully. 

Q. How would you treat appoplexy? 

A. It depends upon general causes and conditions generally. That 
is, it generally occurs in elderly people, where they are not used to much 
exercise and after they have run for a train or to a fire, the heart is excited,, 
and the vessels being weak and the general tone of the system being relaxed,, 
there is a break of a small capillary in the brain and the formation of a 
clot. Perhaps it does not extend farther than congestion of the brain. 
Sometimes it is in cases of people who ha\e long been bothered with con- 
gestion, and the blood does not circulate properly through the brain or 
body, and too much is thrown to the head. You would have to relieve the 
general causes, and you must in some way call the overplus of blood from 
the head. In that case you would treat over the superior cervical 
region particularly, and then to get your effect }'ou would have to work 
over the solar plexus and the splanchnics to draw the blood from the head. 
That in general is the treatme-nt. Of course you understand these are just 
snapshots. I cannot say much on any of these subjects here. What I 
have said is simply as far as my knowledge has gone. 

Q. What would you do in case of meningitis? 

A. Meningitis is a germ disease affecting the spinal cord itself. I have 
treated chronic cases. In the case of an infant of two and one half or three 
years of age the symptoms were a drawing back of the feet until the body as- 
sumed the form of a bow, a dribbling of saliva from the mouth, a lack of 
growth, the lo\ver part of the body being undeveloped. 

In an acute case the first thing to do would be to give a hot bath, evacuate 
the bowels; everything should be done to get the poison out of the system; 
when that was done I would give the patient upon rising in the morning, spinal 
treatment together with treatments upon the kidneys, liver, bowels and lungs. 
I am treating a case at present somewhat similar to this. 

Q. What would be your method of treating the spleen when there was 
trouble there? 

A. I would raise the ribs from the eigth to the twelfth on the left side, 
correcting any obstruction that might exist; giving the abdominal treatment to 
help remove the trouble. In malaria, where the spleen is congested, free the 
blood supply by working from the eighth to the twelfth dorsal vertebrae. 

Q. How would 3^ou cause vomiting by Osteopathic treatment? 

A. This is sometimes very very hard to cause. Some people never vomit 
no matter how sick they get, and others vomit at the slightest provocation. 



QUESTIONS. 20I 

I have known of vonjiting following manipulation of the solar plexus, and also 
upon deep pressure in the third left intercostal space. 

Q. Give treatment for reducing fever. Is there any way to keep the fe- 
ver from returning? 

A. You might keep it down temporarily. I have seen cases of typhoid 
fever where the fever was kept down, but evidently the cause was not removed. 
Always see to removing the cause. 

Q. Is thtre any effective treatment for barber's itch. 

A. I do not know. I would open the pustules with a sterilized needle, 
sterilizing the pustules with carbolic acid. 

Q. What is the treatment for colic? 

A. Ordinar}^ wind colic, the kind that babies have in the night, is caused 
by a disordered digestion. The treatment is to work the wind off the stomach, 
then stimulate the solar plexus, and work along the sp!anchnics. 

Q Is neuralgia successfully treated? 

A. Yes, the treatment for neuralgia is by inhibition. Sometimes it is 
caused by poisonous blood; sometimes by a pressure upon the nerves. 

Q. In case of a paralysis of the lower limbs, where there has apparently 
been no circulation for three years, and after the patient had greatly improved, 
w^ould the appearance of rash or boils have any bearing upon the case? Is this 
old waste matter, which has been dead for so long, carried off in this way? 

A. [ take it that the appearance of rash would be a good symptom, show- 
ing that the blood supply had been renewed. I have a case of liver trouble 
where the body was covered with rash; the rash disappeared and I take it as 
a sign tha. the patient is improving. 

Q. How would you treat convulsions in a young child? 

A. Convulsions are sometimes caused by intestinal worms; by congestion 
at the base of the brain; sometimes by a congestion of blood vessels or some 
displacements. 

Q. Where and how treat for eczema? 

A. I have seen cases of other troubles complicated wnth eczema and the 
result of treatment has been good. Usually the patient does not stay by the 
treatment long enough to get the desired results, as it is a slow process. The 
point is to build up the blood and purify it by treating all the avenues of ex- 
cretion, and in that way remove the poison from the blood. 

Q. Shell fish being eaten, hives appear on the skin, (^as a result of the 
food), and too long a time having elapsed to expel the food by vomiting, how 
could you treat this case to overcome the conditions where you could not expel 
the food at once? 

A. If it was so that I could not cause vomiting, I would stimulate the 
bowels by the method already indicated. 

Q. Please explain how glasses seem to give temporary relief when taken 
off for possibly five minutes? 



202 QUESTIONS. 

A. I would conclude that the patient was growing away from the glasses. 
I would consult an oculist. 

Q. Would you suggest any other treatment for measles other than keep- 
ing the bowels open? 

A. Stimulate the lungs, because the poison seems to take root in them. 

Q. How do you slow the heart's action? 

A. By inhibition in the superior cervical region, and by raising the upper 
left ribs. 

Q. Please explain in detail the treatment for sea sickness. 

A. Inhibition of the pneumogastric by thrusting the thumb into the 
third intercostal space on the left side. This treatment is also applied in the 
third and fourth intercostal spaces upon the right side, and in the fourth inter- 
costal space upon the left side; to this I would add inhibition of the solar plexus 
by putting a pressure upon it, and stimulation of the pneumogastric nerves. 

Q. What it the treatment for locomotor ataxia? 

A. A thorough spinal treatment. This is a disease of the spinal cord. 
Stimulate the flow of blood to the cord from one end of tlie spine to the other. 
Give attention to the local symptoms according to their nature, e. g. for diar- 
rhoea, constipation, loss of control of bladder or bowels; give the usual indi- 
cated treatment, with stretching of the lower limbs. 

Q How do you treat insomnia? 

A. Stimulate along the spine to increase the circulation; treatment in the 
neck; thoroughly relax the muscles of the neck, reducing any dislocations or 
slip between the vertebrae, and finally, inhibition of the superior cervical 
ganglia. 

Q. How would you treat a child troubled with worms? 

A. Through stimulation of the liver, causing an increased secretion of 
bile sufficient to expell such parasites. The stomach and intestines should be 
stimulated as well, and the child should avoid eating sweets. 

Q. What do you inhibit in the neck for cutaneous circulation? 

A. The inhibition of the superior cervical ganglion gets its effect upon 
the circulation in two ways: ist — through connection with the sympathetic 
directly, and second through its connection with the medulla by way of the 
sympathetic; the treatment, therefore, in this region influences the general cir- 
culation to the body in that it affects the vaso-motor center in the medulla. 

Q. In what respect would a general treatment be compared in its general 
effects to a specialized or local treatment of a lesion? 

A. A very general question. A general treatment would be to affect the 
general circulation and the general condition of the nerves; a local treatment 
correctly speaking ought to affect the circulation of the affected part under 
treatment. This only in the most general terms. 

Q. Would not the tendency be to secure better results for a specialized 
treatment of the lesion in that a supply of blood would be drawn to that par- 



QUESTIONS. 203 

ticular point alone and thus be better than the diffused state in the general 
treatment? 

A. In general, I would say the more specific your treatment is, the more 
-directed to the locus of the spinal lesion, the better. The tendency of giving a 
general treatment is far too great already. General treatments should be ju- 
diciously employed as an adjunct to special treatment rather than as a hit and 
miss plan to affect the lesions. 

Q. How do you treat for cold feet? 

A Stretch the limbs by flexing the knee against the thorax, and by ro- 
tation inward and outward, thus relaxing the muscles and correcting the blood 
supply. 

Q. How can the bowels be moved quickly. 

A. I should try a strong stimulation of the liver. In obstinate cases of 
constipation we frequently use the anema first. 

Q. Where you have high fever caused by absorption of poisons in the 
blood, what should be the treatment? 

A, Stimulate the kidneys and bowels and lungs, also cutaneous circula- 
tion; induce copious sweats, thus throwing off the poisons from the system; 
and work as already indicated to reduce the fever. 

Q. What is the best plan to set lateral dislocation at the first and second 
■dorsal. 

A. I work as follows: Set the patient upon a stool with his back toward 
me, and use the head and neck as a sort of lever, so to speak, placing the 
thumb of one hand upon the side of the spine of the vertebrae on the side to- 
ward which it has deviated; the other hand being upon the back of the head. 
I now bend the head down away from the vertebrae in question, thus exagger- 
ating the defect, pushing strongly down to the side, meantime pressing with 
the thumb upon the spine of the dislocated vertebras in a direction toward that 
from which it has rome. The head is next pushed around to the affected side, 
thus relaxing the ligaments, while the vertebrae is firmly forced back into 
place. 

Q. Can parasites be removed by Osteopathic treatment? 

A. The treatment has already been indicated, in part; I would add treat- 
ment of the liver, strongly stimulating the flow of bile; this the ''Old Doctor'' 
says is sufficient to remove intestinal parasites. 

Q How would you treat to relieve a very chilly feeling? 

A. Through stimulation along the spine in the upper dorsal region to ac- 
celerate the action of the heart and lunp^s. 

Q. How would you treat a case of tooth ache? 

A. Send patient to the dentist. We have in a few cases had good re- 
sults by inhibition! of the fifth nerve, reaching it in ways already indicated in 
the course of these lectures. 

Q. Is it dangerous to reduce bacterial fever? 

A. The theory that it requires heat to destroy them would indicate as 



204 QUESTIONS. 

much. In general I would say it is our practice to reduce such fevers. While 
perhaps the high temperature of the bod}^ might tend to render the bacteria 
less productive of evil results, yet further treatment which we employ in such 
cases would seem to make it safe to reduce the fever as we always do. Of 
course, we never omit in such a case to strongl}^ stimulate the action of the 
bowels, kidneys and lungs, to throw off both the bacteria or their products. 
Here this treatment, coupled with the general spinal treatment, tends to pro- 
mote health}^ metabolism, thus building up the tissues of the body, blood in- 
cluded, and to render it less liable to the growth of bacteria. In other words 
the theory of bacterial origin is that there is a so called nidus, or "nest," in 
the tissue in which the bacteria may grow. It is held by eminent authorities 
that bacteria will not grow in unhealth}^ tissue, hence if the 
nidus exists in unhealthy tissue, the work of the Osteo- 
path in building up the tissues does away with the nidus, the ever present ten- 
dency being toward the normal, aiding in such a way as to cause the tissue at 
this particular locality to become healthy. Thus the nidus is destroyed, and 
the poor bacterium is left without a home. In regard to the germ theory, and 
in its relation to Osteopathy, I might say that while the Osteopath acceots such 
theory in general, he, remembering the fact that unhealthy tissue only can 
form a nidus, esteems it conclusive that there must have been a cause for the 
previous presence of the bacteria there, or there would not have been any nidus. 
Ke simply sees that the bacteria may become secondary causes of disease. Here 
his treatment is devoted to removing the primary cause, preventing the bacteria 
from gaining a foot-hold in the body. 



PRINCIPLES 



— OF- 




OPATHY 



lPJL.TtT T^SATO. 



-BY- 



Gtias. HaKzerdI, Ph.ig. D. D., 



Professor of Principles of Osteopathy in the American School of Osteo- 
pathy and Member of the Staff of Operators in the A. T. Still 
Infirmary, Kirksville, Missouri. 1898-99. 



KIRKSVILLE 

JOURNAL PRINTING CO. 

1898. 



PREFACE. 



Since the first appearance of this work, the course o-f lectures of' whicbi 
the first edition was composed, has been increased m number to forty- four. 

The first edition contained discussions of theory,, together with a re view" 
of the human body, part by part, with indications for Osteopathic examin- 
ation and treatment of the same. The second edition contains in addition,, 
lectures upon specific disease, with descriptions of the Osteopathic method of 
examination and treatment of the same. A limited number of cases has been 
thus treated, the idea being not to make this vohime a Practice of Osteopathy, 
but to show the method employed in diagnosis and treatment of the several 
different classes of cases that the Osteopath meets in daily practice. For ex- 
ample: acute condiiions, such as typhoid fever, diarrhoea, and the like,, and on 
the other hand, chronic affections, such as spinal curvatures, constipation and 
other complaints of a similar nature, have been dealt with. 

To this there have been added a few lectures upon the History of Medi- 
cine, and a brief consideration of other systems of healing, such as Faith Cure^ 
Massage, Electricity, etc., in order that the student may know the principles 
of such systems, and learn to point out the independence of Osteopathy from 
them all. Chas. Hazzard, 

Kirksinlle, Mo., Jan. 30, i 



COPYRIGHT 1898, BYCHAS. HAZZARD, D. O. 



Principles of Osteopathy. 



IvECTURK I. 

SPINAI, CURVATURKS. 

The Osteopath meets with many cases of spinal curvature in his daily 
practice, no matter where he may be located. It is a common and much 
dreaded disease. The Osteopath gets many cases to treat because he is the "bone- 
doctor," and people are quicker to come to him with such complaints, or, it 
may be, the failures of the usual modes of treatment adopted by the medical 
profession leave man}^ cases for the Osteopath. He is successful in a fair num- 
ber of cases, but finds many of too long standing to be cured by him, though 
he almost invariably benefits them. In curable cases, his success is flattering, 
presenting the most complete cures. 

Of these, lateral, and simple posterior curvatures are most easily cured. 

The importance of the spine has been noted. It might be called the foun- 
dation of the skeleton; since it supports all the important parts of the body, 
perhaps on the whole, more than do the limbs. It gets but little rest; e. g. 
any one with a troublesome "backache" finds the spine very much in evidence; 
at times neither sitting, standing nor lying, in any position will relieve the 
pain of the ache. Osteopaths should be careful of their own. 

To fulfill its functions, the spinal column must be at once strong and flex- 
ible, and the wonderful device by which this object is accomplished is worked 
out by means of an intricate arrangement of bones, ligaments and cartilages, 
muscles, blood-vessels and nerves, each of which seems liable to its particular 
disability. The cancellous bodies of the vertebrae are liable to caries and 
necroses; the intervertebral discs, to ulceration, suppuration and changes of 
form from pressure; the ligaments to strains and rheumatic aft'ections, the 
muscles to paralysis and spasms; and the blood-vessels and nerves, in this situ- 
ation, to compression and abridgment of function. Hence it is that to the Os- 
teopath the spine becomes the foundation in a different and very important 
sense, and he, regards the condition of the spine, rightly, as experience proves, 
to be the foundation of health or, disease. 

The fact of the compressibility of the intervertebral discs is one of great 
importance: 

I. The whole spine becomes ".settled" down together, rigid, smooth, 



4 POTT'S DISKASE. 

interfering with general nerve connections; causing nervous and special organic 
diseases, and functional troubles. 

2. Any single or several discs may be altered in shape by pressure, e. g. 
altering spinal equilibrium and interfering with important nerves or centers. 

3. May be ulcerated and eaten away, leading to ankylosis and leading to 
permanent injury of the joint. 

4. Important part of spinal treatment is to separate vertebrae and allow 
discs free blood supply and room for growth. Treatment by suspension ac- 
complishes this, as does also traction of the spine, described to you as a « 
"straight pull." 

Question of slight vs. extensive change in form of spine, with vast dif- 
ference in effects: i. Latter is gradual and parts become accommodated to 
changed shape of the spine. 2. Former more severe and accompanied by 
acute pathological state of tissues. Question hard to answer, e. g. Hunch- 
back and good general health vs. slight slip. 

Several kinds of spinal curvature are described: i. Pott's disease (Pos- 
terior angular curvature.) 2. Scoliosis (Lateral curvature.) 3. Kyphosis 
(Post, round shoulders.) 4. Lordosis Ant, (Ant. in lumbar.) 5. Spastic 
(Spasms of muscles.) 6. Hysterical. 

Pott's disease (Percival Pott), an inflammation of the spine, characterized by 
destruction of the cancellous bodies of the vertebrae and intervertebral discs, 
leaving the front parts of the vertebrae to settle together and produce post, 
angular projection, called also tuberculosis of spine, caries or osteitis of spine, 
post, angular curvature, anter.-post. curvature, spondylitis, etc. 

The ulceration and destruction of the bodies and intervertebral discs may 
be partial or complete; the process may begin in either structure, and it usually 
terminates in ankylosis of the affected joints. Usually the disease begins in 
ulceration of the cartilage, and the adjacent surfaces of the vertebrae suffer 
from caries and necrosis. When the bodies of the vertebrae are the first to be 
attacked, they suffer from primiary necrosis, which seems particularly liable to 
attack cancellous bony structures. The disease spreads to involve a greater or 
less amount of the anterior portion of the spine, destroys it, and causes the 
characteristic posterior projection. This is most characteristic as angular curva- 
ture when it occurs in the middle dorsal region, the long spines causing the 
peculiar angular appearance. But in the cervical and lumbar regions merely 
an obtuse post, projection obtains, on account of the shorter spinous processes 
in these regions. Kven this amount of curvature may be absent in well marked 
cases. 

Pott's disease is most usual in children between three and ten years of age 
and of a tubercular diathesis, but all ages and conditions are subject to it. It 
seems to be fairly rare; one in thirteen of my cases, this one being typical. 

The Etiology of this disease is particularly interesting to the Osteopath 
for two reasons: i. It introduces the germ theory, which will be discussed 
later, in connection with Osteopathic treatment of spinal curvatures. 2. It 



POTT'S DISEASE. 5 

emphasizes the importance of slight mechanical causes, e. g. blows, wrenches, 
or strains, etc., as factors, or rather, as original causes, in the production of 
disease. 

The American Text Book of Surgery states that while slight traumatism 
is usually the cause to which the disease is ascribed, the tubercular diathesis or 
soil is essential to the production of the typical disease. Quain, however, lays 
more stress upon violence as the cause, and states that frequently cases are met 
with whose family history is free from scrofula, and Farnum, in a text of April 
'98, says that the microscope fails to reveal the tubercle baccilli in but a few 
cases. Thus the doctors disagree. Cases are frequent in children after dis- 
eases such as whooping cough, measles and scarlet fever, in which the consti- 
tution is weakened. In the adult, syphillis and rheumatism predispose to the 
disease, as they affect the joints. 

The direct cause seems to be generally some violence. Quain, speaking of 
cases in children of good family history who had never had any sickness, says: 
*'In such cases we can hardly doubt that vSome slight accident met with in bois- 
terous play, must have been the immediate cause of the disease: and in some 
instances the writer has obtained undoubted evidence of this fact." He also 
mentions such a cause as the strain upon the spine occasioned by 
a man, in sport, catching a child by the arms, and swinging him 
around upon his back. The violence of course may be direct and 
severe, as in bad falls and blows. The Osteopath continually emphasizes 
the importance of such injuries as causes of disease, through the effect 
they have upon the spine, not so often in producing curvatures, but 
in producing unnatural conditions in the spine, which interfere with nerve 
force and cause various diseases. What others forget he strives to remember, 
and frequently is sure that some old injury, either unnoticed or long forgotten 
is the source of present ill. Frequently the patient will recall such causes. 

^TioisOGY.- — Constitutional — e. g. syphillis, rheumatism, scarlet fever, 
measles, whooping cough, etc., tuberculosis, scrofula, local violence, direct or 
indirect. 

Pathology: — Caries and necrocis, ulceration of discs and formation 
of the angle have already been noted. Further consideration of the 
pathology raises additional points of significance to the Osteopath. 
The inflammation of the parts may effect the cord itself (myelitis) 
causing paralysis which varies according to the region of the cord 
affected. Or, the inflammation may cause what is known as inflammatory 
pachymengitis, i. e. a thickening of the fibrous tissues between the dura-mater 
and the walls of the spinal canal. Their growth may occur only along the an- 
terior, pressing upon the anterior part of the cord and the motor nerve roots, 
causing motor paralysis. This is the most usual condition, but the growth of 
tissues may affect both anterior and posterior parts of the cord, causing 
both motor and sensory paralysis. Sequestra are formed (^portions of 
the bone eaten off and surrounded by fibrous coat,) or deposits occur and bring 



6 POTT'S DISKASK. 

pressure upon the cord. The same may be caused by the dislodged vertebrae^ 
of by narrowing or obliteration of the canal. These causes, of course, irritate 
the nervous mechanism, and pervert or suspend its operations, e. g., the irrita- 
tion may be upon a certain center, be transmitted from cord to sympathetics 
and affect any important organ or organs in their vital operations. These are 
the reasons for the great pain and distress and the very bad general health not- 
ed in a patient with Pott's disease. 

Just so the Osteopath in any ordinary case lays great stress upon any strain 
or injury to the spine, i. Strain followed by inflammation and thickened tis- 
sues. 2. Hyperaemia affecting centers. 3. Slips or twists of vertebrae 
causing direct pressure, or act as strains. 4. Deposits irritating centers, 
etc. 5. Rheumatic affection of the joints. All affect nerve mechanism, reach 
the sympathetic system usually, and have far reaching results. This is shown 
in its worst form in Pott's disease. Muscular rigidity seen iu Pott's disease is 
due to deep irritation of the nerves acting reflexly upon the muscles 

Symptoms: Variable, according to part of spine alfected. The early symp- 
toms are ill-defined (first six to nine months making diagnosis difficult) but 
the patient lacks energy, is irritable, not well; poor vitality. There is pain 
upon motion and upon percussion of affected parts of the spine. Muscular 
stiffness and rigidity become prominent on account of irritation of nerves; 
patient makes unconscious efforts to shield the part from. pain. The muscular 
stiffness causes characteristic attitudes: cervical, wry-neck; upper dorsal, neck 
pushes forward, chin raised and shoulders fixed; lower dorsal, military attitude; 
lumbar, lordosis, by contraction of the psoas muscles. Abscesses following along 
the psoas may contract the thigh and cause the case to resemble hip-joint 
disease. 

While the chief deformity of Pott's disease is spinal curvature, this feature 
may be absent in cases where the disease develops late in life. A slight lateral 
sweep of the curve may occur, indicating destruction, of the lateral 
portions of the vertebrae. Secondary curves are formed, e. g: dorsal kyphosis 
with lumbar Lordosis. Quain notes two points at which may occur a spurious- 
form of posterior curvature, i. e. seventh cervical and first dorsal vertebrae, 
also eighth and ninth dorsal vertebrae, naturally prominent points. This con- 
dition being sometimes exaggerated; accompanied with pain. This is not real 
curvature. The former (seventh cervical and first dorsal vertebrae) is often 
noticed in hysterical girls. 

Pain is an important symptom, being both local and distant, being roused 
locally by percussion. Yet the patient complains but little of pain along the 
spine, it usually being referred, e. g., in cervical disease to the throat, neck and 
arms; in dorsal disease, to the chest, intercostal and epigastric pains, coughing 
and palpitation of the heart; in lumbar disease the pains are colicky, the blad- 
der is irritated and pains shoot down the lower limbs. Motion increases the 
pain, e. g. turning, jumping or pressing down the head. This fact causes the 
patient to hold the spine as quiet as possible. The pain, not usually acute. 



SPINAL CURVATURES — CONTINUED. 7 

becomes sometimes lancinating. Some few cases ran a slow course, it is said, 
with but little pain. Paralysis is a frequent symptom; may affect the lower 
limbs, or the sphincters. On an average it lasts from one to three years. Pe- 
culiar attitudes constitute another important symptom. The patient goes 
about supporting himself upon some object, e. g. furniture. If the disease is 
cervical or upper dorsal, he rests the chin upon the elbows, if lower, he rests 
the hands upon the hips, or walks about with body bent and hands supported 
upon the knees, always with the effort to relieve the affected portion of the 
spine of the superincumbent weight of the body. 

Abscesses are frequent. They occur as retro-pharyngeal, dorsal, iliac, 
lumbar, or psoas abscesses, being the products of suppuration following the 
ulceration and destruction of the parts. The pus gathers in the sheaths of the 
muscles and comes to the surface at the points named. Osteopathy, if used in 
time, should prevent their formation or cause them, where small, to be ab- 
sorbed. 

There are with Pott's disease, general constitutional disturbances, asthma, 
heart disease, indigestion, abnormal temperature, (99° to 101° F), fretfulness, 
chills, loss of appetite, cold extremities, etc The disease, if left to run its 
course, terminates in bony ankylosis of the affected joints, and cure, with per- 
manent deformity as an essential of such cure, or it ends in death from paraly- 
sis, myelitis, and general ill health. 

Mortality in children 1-20; in adults 1-5. Thus the prognosis is more fa- 
vorable in children than in adults, and unfavorable in proportion as the disease 
progresses rapidly. 



CHAPTER II. 

Lateral Spinal Curvature: — Scoliosis, This is perhaps the most 
common form of spinal curvature, and is, fortunately for the patient, usu- 
ally (readil) ) cured by Osteopathic treatment. By far the larger per cent. 
of the cases coming under my supervision have been lateral curves. In 
lateral curvatures, called also Scoliosis and Rotary Lateral Curvature, the 
spine describes two or more lateral curves, according to the American Text 
Book of Surgery; other texts do not thus imply the invariable presence of 
the secondary curve. I have seen cases in which there was but one lateral 
deviation. The rule, however, is to have a second lateral curve with its 
convexity in the opposite direction, while there may be three, or even four, 
or five curves, each compensatingthe other. I am treating a case at present 
in which there are two; there has been a third, but that has been straight- 
ened out. That was in the lumbar region. The primars' curve was in the 
dorsal region. There was one up in the cervical region as well. Another 
case, which I might treat as similar, was one in which there was a very bad 
curve in the neck, followed by a very marked lateral cur\'ature between the 
shoulders. 



8 LATERAL CURVATURE. 

Practice of Osteopathy. Idea of Co7npe7isatio7i\ — Curvatures caused by tilt- 
ing of pelvis or dislocation of hip. I believe I spoke of this matter of 
compensation the other day. That is, nature is undertaking to restore the 
equilibrium of the body which is lost by the formation of one lateral curve, 
and this may be further carried out in the pelvis or in dislocation of the hip. 
I had a case of dislocation of the hip on the left side which had been fol- 
lowed by lateral curvature in the lumbar region toward the right, making a 
sort of compensation in that way. Again, I had a case in which there was 
wry-neck. The neck bent to one side and even that seemed to change the 
equilibrium, throwing the weight on the opposite side on the sacro-iliac 
ligaments. You see how badly such a casue may affect equilibrium of the 
spine which is so delicate, and thus cause a change in the parts to meet the 
new conditions. 

Lateral curvature is said to be more frequent in girls than in boys, and 
frequently is so slight as to be unnoticed until discovered by accident. I 
had a case not long ago in which there was a marked lateral curvature to 
the left taking in most of the spine from the cervical region down. They 
told me that they had not noticed the curvature coming on until it was pro- 
nounced, and you will find that so in quite a number of cases. 

Aetiology. — The causes of the disease may be local, e. g. faulty position; 
constitutional, e. g. ricketts; or both. The most usual cause seems to be 
weakness, the spinal muscles giving way more on one side than on the other, 
allowing the spine to sag. Such weakness is often apparent as the result of 
rapid growth or of sickness. Dr. Harry Still had a case in which the patient 
had a very tender spine, and we found after we had been treating him for 
some time that he had a slight curvature. These things arise sometimes 
without apparent cause. For instance, I knew a young man in splendid 
health who had a marked lateral curvature. He had had no bad accident or 
apparent cause. It seemed in his case to be simply due to very rapid growth. 
He was over six feet tall. It seems that the system is not always able to 
stand the strain upon it by rapid growth. I had another case exactly simi- 
lar. 

A habitual faulty position, e. g., sitting at a desk, e. g., holding an in- 
fant always on one arm, will frequently cause it. Carrying a heavy weight, 
as school books, or a heavy child, may become a cause. I knew of a young 
lady who carried her heavy infant brother about. Without doubt tkis 
was the cause of her trouble. 

Obliquity of the Pelvis: — I noted a case of a young girl with the left hip 
dislocated upward, the curvature of the spine taking place with the convex- 
ity toward the right in the lumbar region as a compensation. As far as I 
was able to learn the curvature was caused in this way, as the mother did 
not know that it had occurred until I pointed it out. Unilateral muscular 
atrophy, or hypertrophy, or muscular spasms from a central cause will all 
act as causes of lateral curvature. A ricketty condition will also weaken the 



LATERAL CURVATURES. 9 

■Spine and cause this curvature, as will empyema, through muscular fixation 
of the affected side. I have known several cases in which the curvature 
-came on without apparent cause, previous illness or anything of that kind. 
I noted the other day a case of a young man who developed lateral curva- 
ture and had, following that, locomotor ataxia. His case came on without 
apparent cause. Quain assigns heredity as a predisposing cause. 

Anatomical Characters: — The spine does not simply yield laterally, 
but the bodies of the vertebrae turn so that the anterior aspect ot the body 
of the vertebrae comes to look laterally in the center of a curvature having 
described the quadrant of circle. The transverse processes project anter- 
iorlyand posteriorly; the spinous processes, laterally. The bodies turn out- 
ward so as always to be upon the convexity of the curvature. The transverse 
processes are anterior and posterior, the spinous process is laterally in the 
opposite direction from the body of the vertebrae. You see that you have 
a great change in the condition of the spine. I cannot make it appear as it 
naturally would in case of curvature. The discs as well as the bones be- 
come eaten away. You have a condition of changed form of bone, liga- 
ments and muscles. I think that this will well illustrate to you what we 
have to deal with in case of lateral curvature. The relations of the ribs are 
changed, bulging backward at their angles or the convex side carried for- 
ward on the opposite side, and making a deep depression along the 
concavity of the spine. On the convex side the ribs become much 
more oblique than before;. on the concave side, more horizontal and wider 
apart. The bodies always deviate more than the spinous processes, and thus 
you see that you have a coddition that is not fully indicated by the align- 
ment of the spinous processes, so do not be misled by what you see like that. 
Quain does not consider the deviation of the spines any sign of a curvature. 

Patholgy: — The bones, ligaments, muscles and vertebrae all undergo 
a pathological change during the course of the disease, accom- 
modating themselves to the new formation of the parts. The intervertebral 
cartilages become compressed on one side by the unequal pressure, and 
assume a wedge shape, the thin edg(i of the wedge being toward the con- 
cave side. Pressure and absorbtion also graduall}^ alter the shape of the ver- 
tebrae and of their articular processes. You readily see what a strain comes 
upon these processes, and the facets gradually wear away, facing another 
•direction, instead of back and up. . So you see how extensive the change is. 
The vertebrae become more or less wedge shaped, while the direction of 
faces of the artcular processss becomes changed. These structural changes 
confirm the condition of the curvature and make it more difficult to cure. 
If a man comes to you and wants to know how soon you can cure a lateral 
curvature, you will have to tell him that the case is such that )'ou will have 
to alter even the shape of the bone befoi-e you can effect a cure. 

Late authorities describe the muscles and ligaments as relaxed and 
atrophied on the convex side, and contracted and strengthened on the con- 



lO LATERAL CURVATURE. 

cave side. Ouain disagrees with this, stating thatthe muscles are simply dis- 
placed on the concave side, pushed together and thus apparently contracted 
You can readily see how this could be. The muscles and ligaments are 
weakened on this convex side, and become atrophied because pushed out 
of place, while these on the other side will become contracted, because it is 
a rule that if }'Ou approximate the points of origin and insertion of a muscle 
it will contract to conform to the changed position. Ouain says they are 
simph' pushed over and in that way apparenth' contracted, while the later 
authorities, as you will see, say that there is a distinct change of condition. 
on this side. 

Anteriorly the sternum becomes ver\' oblique, and the cartilages of the 
conca\'e side bent upon themsehes. The thoracic and and abdominal, 
organs are displaced and interfered with, often causing organic troubles. 

The lung on the concave side is compressed; the heart may, in some- 
case, be displaced to the right side; the liver and stomach and intestines 
are forced downward; while the kidney and spleen on the convex side are 
said to be usuall\' smaller than on the other side. In cases of a rachitic 
character there is often deformity of the peKis. 

Symptoms: — The' curvature is often so slow in development that it 
remains unnoticed for a considerable time, being noticed first in fitting 
clothes by a dress-maker, and sometimes the suspender slips off the shoulder 
too easily, or one scapula is a little too prominent, or some slight irregular- 
ity in the patient's gait is noticed. One shoulder is higher. If on the left 
(left de\'iation), the right breast and iliac crest will be slightl}' too promi- 
nent, the curve of the waist deeper on the right, and the distance from the 
right axilla to the hip is shorter. Ihat is one place where you may make a 
valuable measurement. I would advise you alwa\s in these cases to make 
measurements. I have a case of very marked curvature, extremely to the 
right; on the left side the hip is up so that the ribs as high up as the sixth 
or seventh rib fall down over the crest of the ilium That is one of the 
most marked cases of curvature that I have seen, and was caused by a fall 
from a swing. Quain states that the diagnosis cannot be made simply upon 
the lateral deviation of the spine, since this often occurs in weakness or in 
h}'sterical conditions. The diagnosis must rest upon the torsion of the ver- 
tebrae and changed direction of the transverse processes. 

Symptoms of nervousness, palpitation of the heart, shortness of breathy 
indigestion, etc., are often present, as are also indisposition to exercise, vague 
feelings of discomfort, and pain and tenderness in the back. 

Suspension will cause the curve to disappear in mild and short time 
cases. Those which do not thus disappear have become strongly fixed. If 
the curve persists until maturity, it as a rule remains throughout life. Oste- 
opathic experience is contrary to this. I might say that cases of people 
well advanced in life have been rendered fairly straight, although it seems 
that maturity has limited our practice somewhat in that respect. It is also 



HYSTERICAL AND POSTERIOR CURVATURES. IT 

stated that the prognosis is unfavorable in proportion to the youth of the 
subject when the curve begins. Here also Osteopathic experience is at vari- 
ance with the authorities. A double curvature is likely to be self limited, 
by the arms of the "S" reaching equality and establishing an even balance. 
Thus you readily see here if you have a curvature occurring first in the 
upper dorsal or in the cervical, you are liable to have a curvature on the 
other side lower down, since nature has to restore the equilibrium. Thus a 
curvature is apt to be self limited, not self cured, but more curves may 
appear as you already see. The long single curve is apt to lead to the great- 
est deformity. The great majority of cases reach a certain stage, become 
stationary, and pass through life with slight deformity and but little trouble 
from the curvature. In some cases, however, progressive deforndtv leads to 
immense distortion. 

Hysterical Curvature: — A form of curvature described as a lateral curva- 
ture which may be made to disappear by causing the patient to bend for- 
ward until the tips of the fingers touch the ground. 

Kyphosis or posterior curvature is a term used to describe the common 
condition of round shoulders, as is usually found in the upper dorsal region. 
The same term, however, is descriptive of ordinary posterior curvature of 
any portion of the spine, but not of Pott's disease, commonly, though some- 
times used as a synonym for that term. Its causes seem to be, in general, 
those which have been described for lateral curvature, viz: faulty position, 
weakness and debility, paralysis, ricketts, etc. For example, it is found in 
infants who have been allowed to sit up too much; in growing girls who 
sit in bad positions at school or at the piano; in professional men who bend 
over desks; or in bicycle riders who assume an extreme position. Old age 
and debility weaken the muscles of the back, and allow the spine to bend. 
Years of hard work, e. g., as in miners, shoemakers, etc., is also a cause. 
Sometimes it is the result of positions assumed to ease pain, as in asthma, 
meritis and rheumatism. 

Fathology. — The chief features are a relaxation of the spinal ligaments 
at the spot affected, allowing a protrusion of the spinous processes, and a 
separation from each other; an approximation of the bodies anteriorly, re- 
sulting in destruction of the edges of the intervertebral discs and of the 
bodies of the vertebrae from pressure atrophy. In old age ossification of 
the joints may have occurred. The stature is diminished. It must be dis- 
tinguished from Pott's disease by the rounded, instead of the angular curva- 
ture; by the absence of muscular rigidity, tenderness, pain and symptoms of 
involvment of the cord. 

It is stated that infants usually recover from the disease spontaneously; 
children generally recover upon exercise. If present at maturit)* it remains 
during life, but amounts to but small deformity in the adult. If occuring 
late in life it is apt to be progressive. 

Lordosis or anterior curvature is rather rare. It is usualh' in the him- 



12 TREATMENT OF SPINAL CURVATURES. 

bar or in the dorso-lumbar region, often being the secondary curvature in 
Pott's disease. In this affection the hips are prominent behind, and the 
pubis is depressed, showing a tilting of the pelvis. The causes are com- 
monly weakness of the muscles and ligaments of the lower portion of the 
spine, as in ricketts and paralysis, great weight of the abdomen, as in ascites 
or pregnancy, and in persons with a naturally large or fatty abdomen, seems 
to be the cause of the trouble. It is met in certain diseases of the hip in 
which the joints are partly flexed. Structural chang^es occur in the nature 
of relaxed and lengthened anterior muscles and ligaments, the reverse being 
true of these posterior structures. Also there is a change of form in the ver- 
tebrae and intervertebral discs. They become wedge shaped by pressure 
atrophy, with their thick edges backward. After macurity the deformity is 
apt to become permanent, but in many cases disappears in a few months. 



LECTURE III. 

To-day I wish to illustrate the treatment of spinal curvatures. In treat- 
ment of spinal curvature we should consider first the theory and in the 
second place the practice. The description of theory might be divided into 
first, the mechanical work purely. We have to do a certain amount of 
mechanical work upon the spine. Parts are out of place and, just as you 
would pile up a pile of blocks that have been knocked over, it is a mechan- 
ical matter to readjust all of the parts which are out of place. That part of 
our work is purely and simply mechanical. You might pile up a pile of 
lumber but if you want to be perfectly sure of its remaining so you will have 
to put supports about it, hence we will have to do something more than 
simply put parts back mechanically. The muscles and ligaments must be 
strengthened and stimulated to hold them in place. Since the muscles, lig- 
aments and vertebrae are affected by blood and nerve supply, these parts in 
the normal spine are retained in position by free and unobstructed supply 
of blood 

We retain these parts in place by strengthening and stimulating the 
nerve and blood supply so that the ligaments, muscles, etc., are kept in 
proper condition. 

First, then, as to the mechanical work. Its purpose, as already indicated, 
is to return parts to place, but we cannot separate these methods of treat- 
ment, the strengthening and stimulating must be used together. Not only 
are the vertebrae out of place, but they are changed in form, they have be- 
come flattened down on one side. It is going to be a difficult matter to 
hold them in place. You must take that into consideration in building up 
the spine. These parts slipped back meehanically are not going to stay, 
the first, second or not even the third time. You will have to keep at work 
on them and return them to place and keep strengthening the ligaments in 
order that they may be held in place. How can you shape the material so 



TREATMENT OF SPINAL CURVATURES. 1 3. 

that it will stand in this delicate column? That question we have to deal 
with in any spinal curvature. A word as to theory. We must build up and 
restore lost parts. Tension or suspension as you may readily see, tends to 
the alignment of the vertebrae. You know how we get this effect upon the 
spine. You can have some one holding the ankles, and you can exert a 
great deal of contraction upon the spine, under ordinary circumstances, 
without danger. However, I have known cases of spinal curvature where 
the patients were rendered bed-ridden by stretching in this way, so you 
must be very careful. It is a part of the treatment to see how much the 
patient can stand. This method of traction is one of the best methods that 
we have, for reasons that I shall show you later as to the theory; but you 
see how it is accomplished, with the patient lying upon his back and with 
the "straight pull." It can also be done in this way; you may have the 
patient sitting (it is particularly good for small children) having the hips held 
down, and raising the upper part of the body by reaching over and raising 
the weight at various points along the spine, from below upward, thus 
stretching the spine all the way along. There is a method frequently used 
by surgeons in spinal curvatures. The method is simple and readily shown 
You have a suspensory apparatus consisting of a bow of steel with two 
hooks on either side and with a ring on the top to hang it up by. From the 
inner hooks are straps leading to the collar which buckles under the chin. 
On the ends of this bow you have straps descending vvith supports for the 
arm. There you have your patient suspended, pulled up with a pulley. His 
feet are free of the floor and you have the weight of the body then all hung 
from the point of the greatest curvature, since upon that point comes the 
greatest traction. That is one of the common methods used by surgeons in 
the treatment of curvatures. I knew it used in one case. The operator 
used such a method in a case of our work. It seemed to be very good. 
The case was a very bad lateral curvature. The stature of the patient was 
increased about three inches in a month, some students are trying this 
method now. I, myself, have not tried it. 

Besides that you can use this motion which I have already shown n'ou. 
Have the patient sitting with his back toward you, his hands clasped be- 
hind his neck. You then reach under the axilla, and grasp the wrist on 
each side, then you push the head forward against the resistance of the pa- 
tient, and stretch the spine back in such a way as to bring tension alono- 
the spine. I think that is a very good movement. The tension that is ex- 
erted in this way is one of our valuable methods of treating spinal curva- 
ture. Another way is to work from the spine, springing the spine toward 
the concavity. Where the spine is deviated laterally I would have the pa- 
tient lie upon the side with the convexity upward. I can then work against 
the convexity, forcing the spine toward the concavity. The muscles on the 
uppermost side of the body are almost entirely relaxed. You standing in 
front of the patient, reaching down upon the vertebra^ bring pressure upon 



-14 TREATEENT OF SPINAL CURVATURES. 

the Spine. I usually push the shoulder down toward the curvature, and 
spring the spine. I find this method very good indeed. You can work 
from above downward or below upward. 

Our second method, then, of mechanically working the spine back into 
place, is to spring the spine toward the concavity. Another way is to work 
against the ribs. They being attached to the transverse processes of the 
vertebrae by ligamentous bands, may thus be used b}' their connection to 
some extent to force the vertebra back into place. The Old Doctor one 
day showed me, in a certain case, this motion: having the patient upon the 
side with the convexity upward, he reached over so that the thumb of the 
left hand was upon the angles of the ribs on the lower side of the body, the 
fingers of the right hand were against the angles of the ribs on the upper 
side. He then spread the ribs as you see me doing, springing the upper 
ones, upon which he was working particularly, down and then upward; 
having sprung them down to relax them from the transverse processes and 
to spread the ligaments; and then upward. This of course helps the ribs 
which are more or less displaced, also helps to draw the vertebra back into 
place. 

Another way is to have the patient sitting. This method is especially 
good in cases where the curvature is high up between the shoulders. Work 
against the ribs in front. You can press with the knee against the anterior 
ends of the ribs and draw the arm up in such a way as to bring tension, thus 
exerting such a pressure upon the transverse processes of the vertebrae be- 
hind as to help bring them back into place. You should be careful and not 
press too hard at the knee there, the ribs being joined to the sternum by 
cartilages which may be ruptured. 

Another motion that I use: Have the patient sitting upon a stool, I 
reach under the arms to the angle of the rib on either side, and then turn 
the patient from side to side, lifting the superincumbent weight off the ver- 
tebrae and springing the spine back toward the original position. Not only do 
I hold on each side against the angles of the ribs, but I may, releasing one 
hand, and grasping the arm, reach over the spinous processes, as }'ou see 
me doing, and thus twist the patient around, get a great deal of force exerted 
against the spinous processes. This is a mechanical manner of springing 
back into place that which is misplaced. Further, you may with the patient 
sitting, stand on the side, thrusting your hand under the axilla on the op- 
posite side, you can thus raise the weight of the patient's body to a consid- 
erable extent. I thrust the thumb againstthe spinous processes, and working 
with this twisting motion, make the thumb a fixed point and spring the ver- 
tebrae back. You can work up and down the spine in that way and tend to 
bring the vertebrae back. ' You will notice a great difference in spines. Some 
are quite mobile, while others are as stiff as iron, and it is ver}^ difficult to 
move them. It depends upon the nature of the case. Another point which 
the Old Doctor lays stress upon, is to begin at the bottom of the curvature 



TREATMENT OF SPINAL CURVATURES. I 5 

and work upward; the idea being that the lower vertebrae are larger than 
those above, and you can work better than from above downward. This 
may not be an invariable rule. You should have a purpose in your work 
along the spine. If every day you attempt to replace one vertebrae you are 
working with a definite point in view. Do not simply work up and down 
the spine. Fix your attention upon a single vertebrae each day and try to 
restore it to position, and working from it up you will succeed better. 

Q. If there were several vertebrae out would you only work upon one 
-each day ? 

A. I would give these general treatments described for the general 
help it would be, but I would direct my attention particularly to getting 
one back into position, though I would not work on one alon.e. 

Reduce the secondary curvature first, because it is later in date, and as 
a rule less in extent. Therefore it is more amenable to your treatment and 
more readily restored. You will find that the secondary curvatures yield 
first. Those which come first, as a rule are more difficult to restore. I 
would first remove any appliances which may have been put on in the shape 
of stays, braces, etc., to allow free motion, freedom of exercise, and the free 
flow of blood. The removal frees the patient from the irritation which 
these appliances bring. I do not say this simply to condemn any other 
practice, but it is our practice to remove them to get the spine to depend 
upon its own strength. So much then for the purely mechanical theor}' of 
our work. 

O. By putting the lower vertebrae back into place would that have a 
tendency to throw the one above back to some extent ? 

A. Yes, sir, as far as you could within limits. The whole tendenc}' is 
tD work the one above back with the lower one. You cannot work upon 
one of the vertebrae entirely independently of the others. That is more a 
plan of work. Work with the intention to restore first one and then the 
other. 

I hardly need to illustrate what I am about to say in regard to stimula- 
ting. You must thoroughly relax all of the muscles along the spine, hav- 
ing the the patient upon his face. Stretch the muscles and stimulate them. 
I think that you you already understand that. I believe I ha\'e shown \-ou 
how to manipulate. 

Further as to theory : You remember I have spoken of the central dis- 
tribution of the sympathetic nerve from the ganglia, supph-ing the liga- 
ments, the vertebrae, dura mater, boneS and vessels. I mean the blood ves- 
sels going to the muscles, cord, etc., and supplying all of these structures 
that we work upon. We are not simply relaxing muscles, but wearcactino- 
upon the sensory peripheral terminals of the nerves, getting the effect 
through them. The action upon the sympathetic thus influencing the s\m- 
pathetic centers, we get the effect upon the spinal column. That 1 bring 
out as a point of theory particularly concerned in our work upon the spinal 



l6 TREATMENT OF SPINAL CURVATURES. 

column. Remember that the ligaments and muscles are holding the parts 
of the spine in place and depend for strength upon proper flow of blood to- 
them, consequently when you are working upon blood supply your work is 
primary. 

Now a word as to the theory connected with the good of bringing 
traction upon vertebrae by a straight pull or in the other ways shown. Ten- 
sion, as you know, spreads the vertebrae and allows the free ingress of the 
blood to the discs and all of the structures concerned. These have been 
pressed out of snape. What you wish to do is to so separate that the 
blood can be thrown to the parts. The effect that you will get is to allow 
the tendency toward the normal to restore parts to normal shape and con- 
dition. So there is one important point in theory as to why we bring the- 
straight pull upon the vertebrae. Thus the vertebrae and the discs are tO' 
be built up. You will not have a straight column or a strong spinal column! 
until that has taken place. 

The process of ulceration and suppuration may be stopped in Pott's, 
disease, so that you may prevent the posterior angular curvature if you get 
your case in time, prevent the fixation of the joints. These remarks apply 
to all the work of stimulation of blood supply along the spine. We, thus 
by all of these means, increase blood supply, strengthen muscles and liga- 
ments, and cause them to hold the ground regained by holding replaced 
parts in place. Of course you cannot always have parts stay where you 
put them. It is, therefore, a process of growth. You must bear in mind 
when a man comes in with spinal curvature, that to cure it will take time. 
It must be slow and natural. This will enable you to explain in a great 
many cases to patients who desire a short period of treatment and expect 
to be cured. 

Spring the spine both ways. Placing the patient upon the side, I spring- 
the spine toward me, then witli the patient upon the other side I spring 
the spine again. You may suppose that you should spring the 
spine only toward the concav-ity, but the theory is this, that is 
springing toward the concavity, then in springing away, you get 
the effect of recoil. Then you must pay attention to the gen- 
eral health according to the symptoms that you encounter.. 
There are various complications of the heart, lungs and internal viscera or 
there may be general symptoms, and you must direct your treatment ac- 
cordingly. Appropriate exercises are good. If your patient has a curva- 
ture in the lower dorsal region, anywhere below the shoulders, he can hang 
upon a horizontal bar by the arms. It is a good exercise for any one. We 
are always shorter in the evening than when we get up in the morning. It 
is good practice, this and other appropriate exercise, to strengthen the gen- 
eral health and strengthen the muscles of the back. This of 
course is not Osteopathie practice, but it is exercise which is useful in aid- 
ing you in your treatment. 



TREATMENT OF SPJNAL CURVATURES. 1/ 

I might say further that the lateral curve between the shoulders is per- 
haps the most difficult, and in addition to general stimulation which we give 
the spine in that region, by working the muscles and springing it from side 
to side, I have a motion which I think is very good, and which I illustrate 
in this way: The patient sittting upon the stool, and I standing at the back. 
I have the thumb of one hand pressed against the spinous process of the 
vertebra on the side toward the convexity, then I spring the head around 
toward this side, at the same time pressing the thumb upon the spinous pro- 
cess back toward the concavity and drawing the head around in that direc- 
tion. This method I have found to be one of the best for reducing curva- 
ture between the shoulders, as well as reducing the dislocation of a single 
vertebra. I think that what I have said you may readily apply to the lower 
dorsal and lumbar curvatures and secondary curvatures without my saying 
anything more now. 

I will speak a few minutes as to the results. In the first place, in Pott's 
disease, very many cases have been helped where they have taken treatment 
in time, and in advanced cases you can do a great deal of good. In advanc- 
ed cases I have been able to relieve fever and nervous symptoms and gener- 
al symptoms from which the patient was suffering, by ordinary work along 
the spine. Often the patient is very weak and you must be careful to not 
treat strongly. There is one patient that I treat very liitle, scarcely any at 
at all, but I reduce the fever, and the patient is always relieved. 

These cases if taken in time, may be saved from deformity by pre\-ent- 
ing an angular curve. Where the abscesses have not entirely formed they 
may be prevented, and the pus may be absorbed. I knew of one case great- 
ly deformed where the symptoms were all relieved, and the patient has 
been enjoying fairly good health ever since. If you get a case earh', good 
results generally follow. 

Kyphosis, posterior curvature, and scoliosis, lateral curvature, in fa^•or- 
able cases are cured. Even where we have not been able to effect a cure, 
we have been able to prevent further progress. We have been able to 
change the distorted parts to normal even after maturity, but the early 
cases give the most gratifying results. This ma}- be accomplished in pos- 
terior and lateral eurvatures. 

We must recognize our limitations. We cannot cure e\erything and 
there are many cases that we cannot help. We are very much limited, but 
we have been able to cure a great number of cases. We have been able to 
cure more cases than any other system. 

A few words as to the methods used by surgeons. They are in spina 
curvatures chiefly mechanical, with prescriptions of drugs for general 
health. One practice in very general use is to have the patient lie flat up- 
on the back to relieve the spine from the weight of the body. Sometimes 
a bed frame is made in this way: an ordinary iron pipe is made into a rect- 
angular frame long enough to accommodate the patient, and a cloth is 



I8 TYPHOID FKVER. 

spread over it and fastened, making a fixed, firm place upon which to lie, 
and which may be readily taken up. There are various appliances which 
are used. Plaster paris jackets are made. The patient is suspended upon 
a frame ajid bandages are applied as near the skin as possible to a perfectly 
fitting under vest. Sometimes these jackets are cut in front and laced so 
the}^ may be taken off, but generally they are left on. Leather and wire 
jackets are made, and ingeniously contrived and especially elaborately 
made braces of great price are used. Objections: All jackets, etc., limit 
motion, prevent exercise, are often unsanitary; impede blood flow. Braces 
often do not fit and are outgrown. Mechanical supports do not allow the 
weak parts to grow strong. Such contrivances irritate nerves and often 
perpetuate the condition they should cure. Of course the parts cannot be 
built up and strengthened, because they are dependingupon something else. 
As a rule we remove these things, and leave the patient to have freedom of 
motion. 

Sometimes they ha\^e the patient assume a position that will correct the 
curvature. There is a seat called Volkman's seat, with the chair seat raised 
upon one side, and the patient sitting thus, stops the curvature by overcor- 
rection. They also have the patient lie down on a table, in such a way as 
to bend the spine. There are various methods used. I thought I would 
explain them to )'ou as they may be useful to you sometime. 



LECTURE IV. 

Typhoid fever, (Enteric fever, Typhus abdominalis) is described as an 
acu e. infectious (but not contagious) disease. I treated a case once where 
the lad}- next door had bottles of carbolic acid set along on the window sills. 
A great many people are afraid of it and think it contagious. It is a long con- 
tinued fever, characterized by certain lesions of the small intestines, which are 
the seat of the disease. 

Aetiology, its cause is now generally held to be a specific micro-organism, 
the Typhoid bacillus, or bacillus of Eberth, which invades the body and propo- 
gates its peculiar poisons, thus infecting the patient and causing the symptoms 
of the disease. 

Contaminated water is the chief avenue of entrance of the germ into the 
body. Not all bad water is thus a carrier of disease. People often use such 
water with impunity. Countless millions of the bacilli exist in the feces of 
the typhoid patients. These are frequently and criminally allowed to go with- 
out disinfection by a good germicide. The water in the soil fiequentl}^ be- 
comes contaminated with sewerage which finds its waj^ into wells, or rivers, 
and thus into the houses in the drinking water. A heavy, washing rain, in a 
town or village not well drained by sew^ers, will wash the germs into wells and 
cisterns; or the same heavy rain, cleaning up the large, well drained city, 
flushes its sewers, and carries its impurities into the river which supplies 



TYPHOID FEVKR. 1 9 

smaller towns below with water for all purposes. I knew of one case in par- 
ticular, in which a little girl, some five or six years of age, in going home from 
school, stopped at an open man -hole in a sewer and played about it for a short 
time, and she was very soon afterward taken with a very bad case of typhoid 
fever, and the cause was laid to her playing about the man-hole of this sewer. 
Such effects may occur. 

Cold does not kill the germ. Impure ice is often the source of the infec- 
tion, as is also adulterated milk and other articles of food. The ice which has 
been used here I think has been the cause of a number of cases, although, I 
do not know that it is so much so at the present time. 

Typhoid fever is not contagious. Clergymen, physicians and nurses rarely 
contract it. But this accident sometimes happens in houses where cleanliness 
is not observed in the matter of bed-clothing, carpets, linen, etc. Quain states 
that emanations from newly opened cesspools, sewers, etc., may cause the 
disease, rarely however, through atmospheric contagion. This theory, I be- 
lieve, is now held to be untenable. 

It becomes at once evident that great care should be taken to disinfect the 
stools and urine, and to adopt antiseptic precautions in washing the linen. 

Typhoid usually occurs epidemically in the Autumn (August-November), 
but in cities, sporadic cases are continually noted at any season. 

Some people never take the fever, seeming to be immune. It is stated 
that heredity seems to predispose to an attack, it being more formidable in a 
patient who has lost a parent by the disease. One attack does not exempt 
from another. Young, robust adults are most frequently the victims, the 
disease seeming to avoid persons with chronic ailments. It is very rare before 
one year of age, less so between one year and fifteen years; most frequent be- 
tween fifteen and thirty years of age. Over-work, mental depressions, shock 
and general debility are predisposing causes. So it is that the child of a 
parent, who has had a bad case of typhoid fever, may die from the disease. 
Thus it is that the child, or the brother, or sister who has watched at the 
bed-side of a patient dying with the fever may have the disease. The shock of 
the loss of the relative weakens the system and they are taken down. Such 
cases occur very frequently, and without doubt it is the mental shock which is 
the predisposing cause. 

Typhoid fever is a disease of the small intestines, and affects chiefly Peyer's 
patches, hence the name Ileo-typhus sometimes applied to it. 

Four stages are marked by the condition of the mucous membrane of the 
small intestines. 

(i) In the congestive stage the whole membrane is swollen and congested, 
covered with a slimy exudation. 

(2) In the case of infiltration, the swelling concentrates upon Peyer's 
patches, disappearing in other locations. The patches swell and become of a 
grayish color. 

(3) In the stage of softenings the glands burst and are covered by a 



20 TYPHOID F£VER. 

crumbly crust, or burst and discharge without formation of crust. 

(4) In the s^aa-e 0/ ulceration^ the -psLtches suppurate and form the Typhoid 
ulcer. The whole gland ma}^ now be sloughed off down to the sub-mucous 
fibrous coat of the intestines, or the muscular coat may be eaten through, and 
perforation of the bowels take place. Blood vessels may be eroded, resulting in 
hemorrhage. While the ulceration as a rule affects the Peyer's glands, the 
latter may be wanting, or little affected, while numerous small ulcerations are 
scattered over the intestines. The large intestine is rarely affected, the ilio-coecal 
valve marking the limit of the disease. The mesenteric lymphatic glands become 
infiltrated and enlarged. The parenchyma of the liver and kidne}^ the muscle 
fibers of the heart, and the iuvoluntar}' muscles generally may undergo granu- 
lar degeneration. From this cause heart failure may become a complication. 

Symptoms: The period of incubation, in which the germ grows in num- 
bers and gains a foot hold in the tissues, is usually about two weeks, but it may 
vary to four. The onset is usually insidious; for a few da^^s before the attack, 
the patient suffer« from headache, malaise, general weakness, dizziness, nose- 
bleed, pains in the back, loss of sleep and appetite, coated tongue, etc. The 
attack proper is ushered in with a chill and vomiting. The chilly feeling may 
be slight or wanting. In typical cases, the bowels ma}- be relaxed, and diar- 
rhoea be present, though often constipation is present. There is gurgling and 
tenderness upon pressure in the right iliac fossa. The attack may come on 
violently with few prodromal symptoms. 

An almost unfailing sign of typhoid is the temperature variation, so char- 
acteristic a course does its rise and fall pursue. During the first week, roughly 
speaking, it rises until it has reached 103 to 105 degrees F., for another week, 
or week and a half, it remains high; then for a week to a week and a half it 
graduall}' descends. The manner of rise is as follows: for the first four or five 
days the temperature increases froai two to three degrees, with a fall of one to 
one and one half degrees F. from evening until morning. After reaching its 
level, it remains about the same, the morning temperature being about from 
one to one and a half degrees lower than that of the evening. During the 
period of decline the morning fall exceeds the evening rise, until the normal is. 
reached. 

While the temperature is almost invariably characteristic, it has been 
known to vary some from the usual course. 

Another important diagnostic sign is the rose colored rash. This ap- 
pears about the end of the first week; frequently absent, estimated so in about 
thirty percent of all cases. The spots are small, reddish, pale, about the size 
of the head of a pin. The^^ appear in successive crops upon the abdomen, 
chest and back, lasting until the end of the fever. They disappear upon pres- 
sure. Individual spots may be observed by being marked about with ink. 
The spleen and liver are enlarged and tender. 

The symptoms, usually spoken of with regard to the week of the disease, 
are in great variety, differing much in different patients. During the first 



TYPHOID FKVER. 21 

week, in addition to the weakness, dizziness, epistaxis, etc., already mentioned, 
the abdomen becomes tumid, the tongue is soft and shows the imprints of the 
teeth. It is covered with a fine white fur which may become heavy, brown 
and flaky as the disease progresses. At first the edges of the tongue are red, 
frequently there appears a red streak down the middle, terminating in a 
wedge-shaped red space at the tip of the tongue. The pupils of the eye dilate. 
During the second week the temperature keeps about 104 degrees F, the pulse 
is weak, soft, often diaotic, and varies from 100 to 120 beats; the face assumes 
a stupid look, the patient is very weak, lies upon the back, slips down in bed, 
following the weight of the body. There is a dizziness, ringing in the ears, a 
dry tongue, but the patient does not ask for water; drinks when it is given to 
him. He answers slowly when spoken to, shows the tongue with difficulty, 
mutters and is delirious. 

In the third week the extreme weekness continues. The bowels are us- 
ually loose, owing to the catarrhal condition of the intestines, the cheeks are 
flushed or cyanotic: the lips and teeth are covered with sordes; the abdomen is 
inflated, and the dependent parts of the lungs solidified. The tem^perature is 
still high; there is a jerking of the tendons (subsultus tendinum,) the patient 
slides further down in bed, and the stools and urine are apt to pass off involun- 
tarily. This is the dangerous week, and the one in which the mortality is the 
greatest. Bed sores frequently appear at this time, and are to be carefully 
guarded against. The patient is stupid and delirious and may pick at the bed 
clothing. In this week the intestinal hemorrhage or the perforation of the 
bowels may occur. The former may not be serious, but the latter is usually 
fatal. They are often brought on by some indiscretion, such as the eating of 
solid food. The climax of the disease is now reached. The patient may die 
from perforation, hemorrhage, weakness, or some complication. On the other 
hand, all the symptoms may improve; the stupor becomes natural sleep; con- 
sciousness return; pulse and respiration become normal. This continues during 
the fourth week, but the patient recovers very slowly. 

Relapses are of frequent occurrence They occur about ten days after the 
the disappearance of the fever. 

Hemorrhages are known by passage of blood from the bowels, nose or 
womb. The patient nears collapse and the temperature suddenl}' falls. Per- 
foration is known usually by a sudden and intense pain in the abdoiiien, bloat- 
ing (tympanites) and collapse. The patient lies on his back with knees drawn 
up. Peritonitis follows. The countenance is pale and wet with perspiration. 
The abdominal walls are motionless in respiration. 

Complications are common, e. g. pneumonia, parotitis, pleurisy, and pul- 
monary gangrene. Various forms occur: e. g.. Abortive typhoid, in which the 
symptoms are light, remission of temperature on the eigth to ninth day; walk- 
ing or ambulatory typhoid, patient gets around,- the symptoms are slight, but 
may suddenly terminate in perforation or hemorrhage. 

Treatment of typhoid fever requires great care and careful nursing. 



22 TYPHOID FKVKR. 

1 . Liquid diet must be strictly enforced from the onset until from five to 
ten days after the fever has gone. Milk, meat broths, and soup are indicated. 
The best is milk v^ith lime water in it to prevent coagulation of the milk in the 
stomach. Milk or beef tea should be given about every three hours. From 
two to four pints of milk may be given a day. 

2. Frequent sponging, (night and morning) with tepid water with a little 
vinegar in it should be employed. Hands and face should be frequently wash- 
ed. Sometimes cold baths are given every three hours. The water should be 
seventy-five to eighty-five degrees F. and the body immersed in it for a few 
minutes, the body being well rubbed afterward ^to prevent internal conges- 
tion. 

3. Bed pan and urinal should be used from the first as the extra exertion 
of sitting up is a serious drain on the patient's strength. Patient should never 
be allowed to get up. 

4. Swab mouth with a wash of equal parts of glycerine and water with 
lemon juice added. 

5. Diarrhoea unless exceessive, more than from three to five times daily, 
should not be interfered with. 

In constipation us^ anema every day or second day. 

6. Keep feet and hands warm by hot applications. In case of relapse 
and sudden fall, heat up well and quickly by hot applications. 

7. Return to solid food very slowly. Not earlier than from five to ten 
days after the fever has left. In all treatment avoid carbo-hydrates, (starches, 
etc.) — such foods as are digested in the intestines. No fat, etc. The solid 
food may be ^zz, lightly boiled or poached; very soft boiled rice, curds, and 
whey. (There is always some one around to feed a patient boiled cabbage and 
pork.) Care should be taken as the patient always has a ravenous appetite, 
and there is great danger of over feeding. 

8. Plenty of water — boiled— should be given. You may give toas twater, 
barley water, etc. 

The object of medical treatment is simply palliative. Hare declaring that 
the course of the disease cannot be shortened. However, Dr. Goltman of Mem- 
phis, Tenn., in the Medical Record, New York, September 17, 1898, states his 
belief to be that early and rigorous eliminative treatment may cause a shorter 
or milder course by lessening toxaemia. In medical treatment as in Osteo- 
pathic treatment, great reliance is placed upon proper nursing, but the former 
indicates a long list of drugs for the various phases of the disease. 

Osteopathic treatment, if early and thorough, is highly successful, in most 
cases generally shortening the course, and in most of the remainder keeping 
down the fever and the untoward symptoms that consume the patient's vitality. 
Dr. Connor, of much experience, states that he can usually have the fever broken 
up within two weeks. Dr. McConnell states that by early and radical treat- 
ment the course may be shortened to five days or less. 

Q. Would it not be injurious to take the patient out of bed to give him a 
bath? 



TYPHOID FKVER. 23 

A. Not necessarily so, as he could be lifted out and back. 

Q. How soon would you reduce the fever? 

A. As soon and as much as you can. Of course it does not stay down 
but we keep at it. We always make it a practice to keep it down as much as 
possible. 

Q. How often do you treat a patient for typhoid fever? 

A. You should go to see your patient two or three times a day and make 
it convenient to go several other times to see if he is getting along allright. You 
should give at least two treatments a day. 

Treat7nent Procedure by Osteopathy: You will find your patient very ner- 
vous, muscles twitching, and perhaps irritable. You can reduce the nervous- 
ness and twitching by carefully relaxing the muscles along the spine. I have 
the patient turned on the side, with as little effort on his part as possible, and 
relax all of the muscles along the spine on both sides. I do not usually put 
him to the trouble of being turned over to the other side. I reach over 
myself to the muscles on the under side. You can in this way get the effect 
on both sides, and the next time you can have him turned on the other side: 
You wuU find by treatment along the spine and by gentle treatment in the 
neck you can usuallj^ quiet the patient. Treat in the neck at the superior cer- 
vical region. The idea is to get the hand flat against these muscles which are 
drawn and sore, and gently turn the head to one side so that you can relax the 
tension. That seems to relieve the tension and aid the blood flow. The spinal 
treatment and treatment in the neck are for these symptoms of nervousness. 
The theory is that we affect the posterior spinal nerves and get the effect through 
the terminal sensory fibres to the sympathetic nervous system, and out through 
them to the vaso-motor and thus equalize the circulation. I think that our 
theory here of work upon the superior cervical region is that we reach the sub 
and great occipital nerves and reach the general circulation through the medulla, 
in that way quieting the nerves. There are special points which are included 
between the second dorsal and and fourth lumbar, (a.) From the second to 
the seventh dorsal to relieve the lungs, as you know pneumonia is one of the 
complications, (b.) Work gently from the fifth to the tenth dorsal for the 
effect upon the jejunum, (c.) From the tenth dorsal to the first lumbar for 
the ilium. We do the most of our work from the tenth dorsal to the first lumbar 
because the small intestine is affected. You may work from the first to the 
fourth lumbar to affect the large intestine, (d.) From the sixth dorsal to the 
second lumbar to affect the kidneys. All your work along here must be very 
gentle. Work against the mu':cles gently, about as you see me doing here, 
particularly from the tenth dorsal down to the fourth lumbar. I work gently 
springing the spine, all the way along, gently toward me as that will stimulate 
and relieve the nerves. The spleen must be looked after in the splanchnic re- 
gion from the eighth to the twelfth on the left side. The ribs from the eighth to 
the twelfth on the left side must be raised gently. I would not take up the 
arms of the patient. I would reach under him and raise in this way. Work 



24 TYPHOID FKVKR. 

over the abdomen and under the ribs in front, not hard, as the spleen and liver 
are likely to be congested and you must not work hard on that account. In 
diarrhoea, where there are more than three or four stools in a day, we inhibit 
the ninth, tenth and eleventh dorsal, the eleventh especially; simply by hold- 
ing against this point, the patient upon the side, and springing the spine. I 
go also to the lumbar region, and hold at the heads of the eleventh and 
twelfth ribs. The theory there is that springing the spine and gently raising 
the ribs releases any tension upon the spinal nerves, and through them affects 
the sympathetics, ruling the organs mentioned. Also treat gently the second 
dorsal and fifth lumbar to influence the superficial fascia and thus influence the 
general circulation of the blood; the cutaneous circulation. 

Fever: — I take down the fever by work here in the superior cervical region 
as I have already shown you. I hold flat against the sub and great occipitals 
for a long time. Do not be in a hurry. You can hold there several minutes if 
you wish, and turn the head from side to side, gently. I also inhibit by spring- 
ing the arm up a little; or b}^ pressing in against the heads of the upper ribs on 
the left hand side, from the first to the fifth to help quiet the heart. In ex- 
treme cases where the heart beat is from one hundred and thirty to one hun- 
dred and forty, Dr. Hildreth says he has had fairly good success by raising]|the 
fifth rib on the left hand side. I would work under the angles ^behind and 
raise both the angle and the tip. Also you will need to lower the first rib 
gently by pressing in behind the clavicle. 

The abdominal treatment is one that must be given very gently. We work 
gently in the iliac fossae on each side. I kneed gently not with the idea of 
helping the constipation, but of getting in deep among the intestines and re- 
laxing the tension upon the lower hypogastric and pelvic plexuses, simply by a 
gentle touch to relieve the tension in this way. Now this work over the liver 
and spleen seems to relieve the tension, takes out the soreness, and thus prob- 
ably, prevents the degeneration spoken of in the spleen, by freeing the blood 
flow, as well as preventing ulceration in the bowel. Probably also there is de- 
generation of the involuntary muscles of the heart, and as soon as you can do 
so you should give a stimulating treatment to restore the vitality, 

Suppose you have a hemorrhage? Osteopathic treatment there would be 
as far as possible to inhibit the peristalsis at the ninth, tenth and eleventh dor- 
sal vertebrae. The best thing to do is to immediately place an ice bag over 
the caecum to contract the blood vessels and stop the hemorrhage, while on 
the other hand, if 3'ou have perforation of the bowels, which is sudden, and 
may be noticed by the fixation of the abdominal walls, etc., hot applications 
are used over the bowels and lower limbs, to relieve the pain. If perforation 
occurs you are almost sure to lose your patient. 

The patient's room should be quiet and'clean, with good ventilation, plenty 
of fresh air, diligent nursing and frequent Osteopathic treatment, but not 
enpugh to in any way worry the patient. Guard against relapses from 
over eating. 



MALARIA. 25 



LECTURE V. 

Malaria, called also Marsh Miasm, Iniermitteiit Fever, Fever and Ague, is an 
endemic disease, dependent upon the presence, in the infected locality, of a 
specific poison generated by a Protozoon germ, Plasmodium Malarise, or 
Haematozoon of Leveran. 

The term Malaria is commonly used in a general sense, to denote a class 
of intermittent and remittent fevers known as the Malarial fevers or diseases. 
This class of fevers is characterized by enlargement of the spleen and liver, 
paroxysmal periodicity, and the presence in the blood, either free or within the 
corpuscles, of various forms of the above mentioned parasite. 

yFtiology. — The cause of this disease is peculiar, and not well understood. 
Although described by early writers as the * 'Bacillus" Malarise, it is now 
generally admitted to belong not to the class of bacteria, but to the class of 
protozoa. It is generated in swampy places as the name (marsh miasm) 
implies, though by no means there exclusively. It occurs chiefly in tropical 
climates, and in places where strong heat from the direct rays of the sun, 
moisture, and decaying vegetable matter are present. It is often met with in 
localities where the soil is rich in organic matter. When the natural drainage 
outlets of a locality become clogged, the ground becomes waterlogged, and 
malaria is very apt to be developed. Malaria is also known in some dry, arid 
regions. I^arge tracts of arable land, left without cultivation, frequently be- 
come malarious. Digging up of the soil, e. g. for the purpose of putting in an 
extensive sewer system, has long been known as a cause of an epidemic of the 
fever. 

The fertile strips of soil at the bases of the mountain ranges in tropical 
countries are seats of the miasm, e. g. base of the Himalayas, where the soil, 
rich, well watered and covered with forest, is notably malarious. Certain 
rocks, disintegrating, exposed to sun and air in tropical countries, are said to 
be productive of the poison, e. g. granite rocks, which are highly absorbent of 
moisture. When you come to consider that the rocks are one of the best fer- 
tilizers known, then you have some idea how they ma}^ increase the value of 
the ground by fertilizing it. 

Decaying vegetable matter m the bilge water of ships has been assigned as 
the cause of an outbreak of malaria. 

Certain low lands along rivers, are known to be especially infected. Our 
Chariton river, it is said, is infested more on one side than on the other. Dr. 
Connor used to tell us in clinics that on the west side, I think it was, the peo- 
ple were very apt to be malarious while those on the east side were not. 

New places, just under cultivation, and places with a damp subsoil, 
though the upper crust is dry, are ver}^ frequently affected. 

Characteristics'. — Malaria is described by Green as being strictlyendemic, i. 
e. limited to certain localities. The disease must be contracted, here though it 



26 MALARIA. 

may manifest itself elsewhere. This would seem most natural from the nature 
of the cause. However, Epidemics of malaria are common occurences, while 
sporadic cases are known. Rane says it is not known why epidemics and 
sporadic cases should occur, as they have been known to occur, in localities 
which have never manifested malarial infections, in individuals who had not 
left the locality. 

The disease is not contagious, it cannot be carried by one person to another. 
One person may be infected from another, says Green, on'y be direct intraven- 
ous inoculation. 

The miasm seems to travel with air currents, and in certain definite plans. 
It may be stopped by a hedge or a wall, unless a strong breeze carries it over. 
It may be found only upon one side of a river, the other side being entirely 
free from it. A forest belt is often a barrier. Under proper conditions it may 
travel long distances upon air currents, provided the strength of the breeze be 
not sufficient ta dispel the germs. They may rise with currents of heated air 
to considerable altitudes which are otherwise healthful. They have been 
known thus to ascend along ravines up mountains from five-hundred to three 
thousand feet in height. Thus it is sometimes unsafe to place a dwelling near 
the edge of a ravine. 

The virulence of the miasm varies some with the temperature, localities 
which are unhealthful in Summer and Autumn becoming safe in the winter 
season. 

There is a theory that tke system of the host may become inoculated 
through the bite of insects, e. g. mosquitoes. However this theory though 
probable, is questioned. 

The Germ: As stated above, the germ of this disease is not a bacterium^ 
but a protozoon. It is always present in the blood, in maleria, either free in 
the serum, or within the red corpusels. Its action upon the blood is marked, 
it being extremely destructive of the red corpuscels. Quain states that Prof. 
Keltch has shown that in twent3'-four hours, a man affected with maleria lost 
more than a million globules per cubic millimeter Thus the patient becomes 
anemic, and this state of the blood causes murmurs about the heart, which may 
lead to a mistaken diagnosis. The germ is seen in different forms at different 
times. The form free within the liquor sanguinis is minute, globular, and 
possessed of amoeboid movements. This seems to be the primary form. Again 
the germ is seen within the red blood corpuscles, amoeboid, pigmented. iVgain 
a large pigmented intracorpuscular form is seen; then an intracorpusnular 
rosette form, with the pigment aggregated at the center; or the flagellated 
form is seen free. 

Some writers maintain that the above forms are different stages in the 
growth of the organism. It ma}', further, be crescentic in shape, or become 
flagellated, the flagellae lashing about in the liquor sanguinis. 

It is stated that the severe types of malaria in tropical countries are par- 
ticularly connected with the appearance of the crescent shaped germ, and that 



MAI^ARIA. 27 

in temperate climates the crescentic form is rarely present, the flagellated form 
being produced immediately from the intracorpuscular discs I^everan first 
discovered the germ. 

Pathology and Symptomatology : The diagnosis of Malaria (typical) never 
fails on account of the clock-work-like periodicity of the phases of the disease. 
Hence the name paroxysmal. There are three stages; the chill, the fever, and 
sweat. 

The chilly stage lasts from a few moments to three hours. The patient's 
appearance is marked. The features shrink; there is a chill, which may be 
violent; there may be vertigo, and nausea. The chill may be limited to a 
slight chilly sensation along the spine. Ordinarily the whole surface is cold^ 
the face is pale; the nose becomes pinched; the breathing is shallow and quick; 
the pulse is small and rapid; but the internal temperature rises rapidly from 
two to seven degrees. Various symptoms attend this stage, such as headache, 
backache, cough, thirst, colic, etc. 

The second stage lasts a variable number of hours; from two or three to 
ten or twelve. It comes on gradually, the body recovering from the chill, the 
temperature continuing to rise until it reaches a height varying from 100 
degrees to 108 or even 109.40 degrees F. Various symptoms attend this stage. 

The third stage also lasts a variable number of hours. In it the fever 
gives away to a profuse perspiration, greatly relieving the patient, the temper- 
ature declining to normal or near normal. This stage ends the paroxysm. 

The patient now may feel quite well, the paroxysm not returning until 
the next day, in which case the type is called "quotidian," or the paroxysm 
is absent until the second day. ("tertian" type), or .finally, until the third 
day, constituting the "quartan" type. Owing to this peculiarity the patient 
often feels quite well and wants to go to his usual occupation. After he is 
well there is a tendency to the return of the trouble on the fifth, seventh, ninth 
or fourteenth day. The stage between paroxysms is called the stage of Apyr- 
exia. The fever is called intermittent on account of the intermision between 
paroxysms. If the stage follows in the order given, the fever is '^intermittens 
compieta;'' if one stage is lacking, ' ' intermitteyis incompleta ,'' if in reverse order, 
^Hnte?mitte7is inversa.'' The most usual forms are said to be the quotidian and 
the tertian. The paroxysms, instead of occuring at regular intervals, may 
come each time earlier (anticipating), or later (postponing). 

The fever is said to be remittent^ when between the paroxysms the tem- 
perature is lessened, but the fever merely slackens, exacerbation recurs immedi- 
ately. The intermittent fever may vary in form, being gastric or bilious, and 
attended with gastric derangement; typhoid, simulating that fever; or of a 
grave form leading to a rapid collapse. The symptoms of the latter form are 
great weakness; derangement of most of the organs; icterus; bleeding of nose, 
stomach or kidneys; dysentery, etc 

When the patient has resided long in a malerial region and has gotten the 
system full of the poison, a low state of vitality exists, with various symp- 



--28 MALARIA. 

toms characteristic of the maleria, but in mild form. This is called ''Mala- 
rial Cachexia.''^ 

"Dumb Ague" is the name given to a variety of malaria, sometimes acute 
but usually chronic, in which the sequence of chill, fever and sweat does not 
occur. The symptoms are irregular chilly sensations, flushes, pains in joints 
and muscles, bronchial troubles, headache and neuralgia, etc. 

Enlargement of the spleen (ague cake) and liver, with soreness of both, is 
a usual feature of all these forms, as well as a constant feature of the regular 
form. These both and the spinal cord become pigmented, probably through 
destruction of the red corpuscles. The urine is often irritating during the 
paroxysm. 

Treatment'. — Now as to medical treatment, quinine is the stock remedy, 
and is said to destroy the germ. 

The Osteopath wants to get rid of the fever and of the poison. He stim- 
ulates as far as possible all of the avenues of excretion through the bowels, 
kidneys, liver and the lungs in the ways already indicated. It will not be nec- 
essary for me to indicate this to you, simple and general stimulation of the 
■excretory system. I think you all know the points at which you work. The 
second dorsal to the seventh dorsal, and also the fascia at the second dorsal and 
£fth lumbar, in all stages generally treat this wa3\ I also treat the liver in a 
way wnth which you are familiar, and the spleen. Work gently, as you must 
bear in mind that these two organs are very likely to be congested in any such 
cases as this, and you must not run the risk of rupturing them. For chill, re- 
lieve the internal congestion, and thus relieve the chill b3^ stimulating the heart 
and by stimulating the superior cervical ganglion. Stimulate the lungs as 
w^ell. b}^ raising the ribs from the second to the seventh on both sides. Give 
also a thorough spinal treatment. Some have said to rub up the spine in order 
to stop the chill, but I do not see why that should be. If you stimulate the 
spine all the way along you thus restore the circulation. When 3^ou find the 
body chilly, warm the patient b}^ hot applications to the spine, feet and in the 
axilla. Also give hot drinks and hot foot baths. Hare says the action of the 
poison at this stage of the chill has congested and engorged the thoracic and 
abdominal organs. Work especially upon the splanchnics and solar plexus in 
front, and work over the abdomen in front to get rid of the congestion about 
the abdominal viscera; and the stimulation about the lungs already described, 
would get rid of the congestion about the thoracic viscera. 

As to the fever, you treat it as any other fever, cold sponging and cold 
drinks have been indicated by Hare. Besides that, Osteopathically slow the 
heart's action by inhibiting. You raise the arm and hold back on the shoulder 
in this wa3^ for a minute or a minute and a half, and this will slow the heart's 
action. Inhibit the superior cervical, the splanchnics, and the lower lumbar to 
equalize the circulation. In the stage of sweating 3^ou should let the patient 
alone, as the perspiration removes the poison, causing the patient to feel better. 
•Give plenty of water to drink, and encourage the perspiration by wrapping up 



RHEUMATISM. 291 

warmly . Give hot foot baths, also stimulate the superior ganglia and lungs 
to help this improvement along. The constipation and diarrhoea you know 
how to treat, as before indicated. In the period of apyrexia, give a thorough 
general treatment for a tonic effect. 

I might say our success is good in malaria if the case is taken in time, but 
if the disease has been coming on for some time it is more difficult to cure,. 
Some two or three months ago a young man came to my house on Sunday with 
his face flushed, and the malaria symptoms very perceptible. I treated him 
that day and the next. He remaied at home several days but he was out with- 
in a few days. 

Where you have a malarial constitution it will probably take some time to 
work this poison out of the system. I have had cases where they would have- 
chills once a week. You can stop the chills and relieve all the symptoms. 



LECTURE VI. 

The various forms of rheumatism are among the most frequent cases that 
the Osteopath is called upon to treat. The fact that m.ost of these cases have 
become long standing chronic cases, makes the average cavSe of rheumatism 
somewhat difficult to handle and slow to cure. Very serious cases of deformity 
resulting from the disease present themselves for treatment. Frequently parts 
are dislocated, e. g., hip, knee, lower jaw etc., simply in the progress of the 
disease. I have had several such cases. One case was of a man in this town 
who had been affected with rheumatism for some years, but one day he went 
up town, and while walking his hip became dislocated. It shows you the 
drawing power of contraction in disease. I have seen more than one case 
where the lower jaw had been dislocated from the same reason. Joints become 
enlarged by the growth of tissues; the synovial membranes are .destroyed and 
chalky deposits are formed in the joints. One of the most frequent phenomena 
you will witness in connection with rheumatism, is the enlargement of the 
joints, for the reason that these cases, in the majority of instances, become 
chronic and this chalky deposit is formed. Consequently it becomes one of the 
main points in the diagnosis of rheumatism. Hence it is not strange that the 
Osteopath frequently finds himself confronted b}^ cases, certain features of 
which are beyond his skill, while at best, they, as a whole, are slow and un- 
satisfactory. It is rare however, that the Osteopath cannot aft'ord immediate 
relief from pain in any case of rheumatism, and, almost without exception, 
cases coming under his care are greatly benefited in most particulars. He can 
reset the dislocated joints, relax the rigid muscles, absorb to some extent the 
articular deposits, and give new freedom to stiffened joints. In almost any case 
of acute Rheumatism, whether muscular or articular, his success is practically 
assured, while in chronic cases he may usually obtain good results. Hence the 
success of Osteopath}^ as a treatment for all forms of Rheumatism is marked. 
The fact that so many cases are of years* standing, coupled with, the fact tliat 



30 RH:eUMATlSM. 

the patient frequently cannot continue the treatment for a sufficient length of 
time to obtain the best results, makes the average of the cases coming under 
the treatment slow and difficult. 

In the special forms of this disease, such as I^umbago, Torticollis, Pleuro- 
dynia, etc., the treatment is very successful. 

There are several forms of Rheumatism, commonly met with: Acute 
Rheumatism, known also as Rheumatic fever and Acute Articular Rheumatism; 
Chronic x^rticular Rheumatism, aud Muscular Rheumatism. These three forms 
of Rheumatism are separate forms. Chronic Articular Rheumatism does not 
necessarily follow the Acute or Rheumatic Fever, although the latter may de- 
velop into the former. Sometimes the person is attacked from the beginning 
with this socalled Chronic form of Articular Rheumatism. They seem to be 
distinct from each other, though the Articular forms, both acute and chronic 
are due to similar causes, and the latter often results from repeated attacks 
of the former. The muscular form is often complicated with the other forms. 

Raue makes the following general statement regarding this disease, ist 
"It attacks either the fibrous tissues, joints, aponeuroses, the sheaths of the 
tendons, the neurilemma, the periosteum, or the muscles and tendons. 2. It 
is a peculiar, painful affection, caused, no doubt, by inflammation and nutritive 
disturbances; and, 3. It comes on independently of other acute or chronic di- 
seases, or traumatic causes, etc" 

Rheumatic Fever, (Acute Articular Rheumatism) is an acute, febrile disease, 
a constitutional disturbance, characterized by fever, sweats, and inflammation 
of the joints and serous membrane of the body. The tendency it manifests of 
attacking any serous membrane makes it frequently a dangerous disease. 

Aetiology. — As to the causes of the disease, they are two fold; predisposing 
and exciting. Among the former are heridity(27) per cent; previous attacks; 
occupation, such as hard out door labor under exposure to the weather; social 
position, poverty being a. frequent cause; and residence in certain districts. 

Among the exciting causes are infection, this being considered by some a 
disease caused by micrococci in the system; exposure to wet and cold; strains and 
muscular sprains; chills from overheating; derangement of the stomach and liv- 
er from the eating of rich food; mental effects, such as despondency and de- 
pression; exhaustion from sickness, lactation, uterine disease, etc. 

Some authorities hold that there is accumulation of lactic acid in the sys- 
tem, acting as a poison to the tissues. Others hold that chilling of the surface 
of the body causes derangement of the parts of the central nervous system and 
vaso-motor disturbances, or pain, or trophic changes. In regard to the chilling 
of the surface of the body and this affecting the central nervous system, you 
see here it is given plainly in the aetiology of such a condition as rheumatism. 
We generallj' understand a cold to be a congestion, but it has been suggested 
that it may be due to a nervous disturbance from chill. If your feet are wet 
or exposed the result may be a cold in the head. It is clear in numerous res- 
pects, and I think the hypothesis of nerve causes is a very reasonable one 



RHEUMATISM. 3 1 

Some regard a chill as affecting nutrition, causing the retention of the lactic or 
other acid, which in turn affects the nervous system, causing affection of the 
joints. There is a germ theory, a specific organism being suspected; and a ma- 
larial theory, due to miasm or poison generated outside of the body. The gen- 
eral difference between the bacterial infection and the infection of miasm is 
that the bacteria get a foot-hold and propogate the poisons in the system as in 
typhoid fever, while on the other hand in malaria, the miasm is generated on 
the outside of the body, and the poison formed is taken into the system by the 
person visiting the locality infected by the poison. 

All this goes to show that the nature of the disease is not well understood 
although a late writer says: "It is apparently becoming more and more 
recognized as a purely infectious disease." (Raue.) 

Pathology: — Structural changes in the joints are sometimes very slight, 
following the inflammation of the synovial membrane; merely a slight exuda- 
tion containing a few pus cells and but little fibrin is noted. There is oedema of 
cellular tissue about the affected joint, causing a visible swelling. One of the 
most frequent symptoms that you will note in cases of rheumatism whether of 
long standing or recent, is that the joints will swell. I am treating a case now 
in which the two fingers on the left hand will swell. Sometimes it will be in 
the hand, and sometimes about the various joints. 

In severe inflammation of the synovial membrane, considerable pus and 
fibrin are present in the exudation, and the ends of the bones may become in- 
filtrated. The heart and large blood vessels contain a large amount of fibrin; 
the cartilages of the joints probably suffer inflammatory changes, when- there 
has been much fever, there is apt to be granular degeneration of the liver and 
other solid viscera. The inflammation frequently attacks the heart, or luno-s, 
or pleura. It may attack the peritoneum, larynx, testes or renal tubules of 
the kidneys. There may be congestion of the lungs, pericarditis, myocardits, 
or endocarditis. It is this tendency of Rheumatic fever to attack the heart es- 
pecially, and the lungs, that renders it so often fatal. It is said that about 
twenty per cent of all cases are complicated with endocarditis; fourteen per 
cent with pericarditis, while myocarditis is quite rare. Pleuritis, pneumonia 
and meningitis are still less frequent. 

Symptoms: — Three prominent and constant symptoms of Rheumatic fever 
are, fever, sweats and arthritis. The fever is variable, frequently, but often 
follows a tolerably regular course. It is present at the outset, and lasts as long 
as the disease preserves its acute character. Usually the temperature does not 
-exceed the normal more than one or two degrees. It is usually moderate if 
the joint symptoms are so, but may rise to 104 or 104.90 degrees F. under an 
opposite condition of affairs. Sometimes the fever rises rapidly and becomes 
very high without respect to other symptoms. The fever is remittent in type, 
rising from one fourth to one degree in the evening. The sweats are acid, and 
the skin is often covered by a fine red or white ash. The perspiration is pro- 
fuse, and of an acid odor, it varies in amount and is most profuse when the 



32 RHEUMATISM. 

pain is greatest. It is said that the odor is so strong and so characteristic that 
frequently the diagnosis can be made from that alone. The sv/eats are not 
weakening, but though unpleasant to the patient, afford him great relief.. 

The arthritis, or inflammation of the joints, is marked by swelling, red- 
ness, pain and heat. Pain in a joint marks the onset of tne attack, it swells 
and reddens and the effect may spread from one joint to another, or remain 
localized at one joint. The joints of the spine and the symphysis pubes may 
be attacked, but the toes are rarely invaded. I had a case in which every 
joint of the body was attacked. The person was practically immovable. Every 
articulation of <-he spine, everything but the lower jaw was attacked by the ar- 
thritis. The kidneys were very bad, the arms w^ere drawn at the elbows, and 
the knees were drawn up to a right angle. There was great pain, perspiration 
and on the whole it was very distressing. The lower jaw usually escapes, al- 
though I have seen several cases in which the lower jaw was attacked. 

The pain is excruciating; much increased upon movement. It begins as a 
sore feeling and may become throbbing. It very gradually disappears, leaving 
a bruised feeling in the joint. The color of the swollen joint is red or pink, 
and feels warmer than the surrounding part. 

The joints most affected are the knees, ankles, shoulders, wrists, and el- 
bows, i. e., the larger joints. 

Besides the fever, sweats and arthritis, there are various symptoms. 

You will notice here a similarity between Rheumatic fever and other spe- 
cific fevers. An attack comes on much in the manner of any acute specific fe- 
ver. There is chilliness, malaise and general debility: sore throat, aching of 
limbs and trunk, flying pains in the joints are noted. The patient lies stretch- 
ed upon his back, careful!)^ arranged that every joint may be guarded; the com- 
plexion is sallow, and the cheeks flushed, Thirst, lack of appetite; frequent, 
weak pulse and slightly accelerated respiration are all present. The reaction 
of the urine is acid; it is scanty and high colored. 

The joint symptoms are transient, usually, passing quickly from one joint 
to another, those sore one day being nearly well the next, while still others 
have been invaded. The tongue is coated with a moist white fur. The tongue 
is sometimes coated brown, or is dry and cracked. Dyspepsia and bowel dis- 
turbances occur. There may be diarrhoea or constipation. 

The urine is scanty, high colored, strougly acid and contains a quantity of 
urates and uric acid, which are deposited as a thick sediment upon cooling. 
Delirium and stupor ma}^ arise, but are rare. Sleep is either prevented or much 
broken by the severe pain. The patient's mind is much disturbed over his con- 
dition, particularly if he has had previous attacks. I have a case of a little 
girl in which the disease began with a sore throat. Both arms and both limbs 
are affected, and the right hip has been drawn out by the disease. She has 
been affected this way for five or six years. In all respects the bodily health 
is excellent. The kidneys are in a healthy condition. The urine is frequently 
analyzed, and only in case of cold does the urine show a departure from the 



RHHU.AIATISM. 33 

normal. She is fat and has splendid general health. This shows what se- 
vere cases of specific disease may exist in which the general health will be good. 
This is something that I have wondered at, and something which I think 
you will notice. 

Course, Duration and Termbiations'. — Children and old people are rarely at- 
tacked; the majority of cases occuring between the ages of fifteen and forty. 
Men are more liable to it than women, probably because they are more exposed 
to conditions of the climate. Robust persons are more frequently victims than 
are debilitated ones. The disease is more common in the spring and winter 
seasons, and is observed in all climates, though most trequenlly in temperate 
ones. 

The course does not follow a regular cycle, but is variable. The attacks 
may pass off in ten or twelve days, or may worry the sufferer for many weeks, 
finally passing into a more or less chronic form. 

Convalescence is as a rule tedious, miay be accompanied by desquamation 
of the hands and feet, or of the body generally, and is frequently followed, if 
not by more severe sequelae, by pain and weakness in the neighboring joints. 
The remote effects of the disease frequently persist during: the rest of the life, 
and are sometimes considered of more consequence than the original attack. 
Such are chronic arthitis; heart disease, especially valvular; disease of the lungs, 
brain, kidneys, or vascular system. 

Complications'. — Various complications arise in the course of tte acute at- 
tack; rendering it more serious and more difficult to deal with. Organic heart 
disease is most common, fifty per cent being the estimate. It is said that chil- 
dren and youths seldom escape it. Its presence is more common in severe at- 
tacks, women seeming to be more subject to it than men. If the case is neg- 
lected, heart symptoms are more likely to appear. 

Complications of diseases of the lungs are likely to occur, and are respon- 
sible for death in a large proportion of the fatal cases. Such are pneumonia, 
pleuro-pneumonia, pleurisy, bronchitis, and pulmonary bronchitis. Other com- 
plications are renaL serous intlammation, gout and scarlatina. 

Diagnosis: — The diagnosis is usually made without difficulty, but is often 
rendered a matter of great difficulty by the tendency manifest, in the period of 
invasion, to resemble in its symptoms the acute specific fevers. The diagnosis 
rests upon the family history, the history of the attack, the pain and tender- 
ness of the joints, the moving about of the joint symptoms from joint to joint, 
and the acid sweats. 

Prognosis: — As regards death is good, only about four per cent of the cases 
being lost. But as regards succeeding health, it is described as most uncertain, 
owing to the variety of complicatious, and the uncertain course of the disease. 
Under Osteopathic practice the prognosis is good for Acute Articular Rheuma- 
tism. It runs a mild cour.se in children and old persons. One must be guard- 
ed in prognosis in cases of patients who have cardiac or lung symptoms, or 
weakness. 



CHRONIC ARTICULAR RHEUMATISM. 



LECTURE VII. 



T wish to call 3^our attention to a couple of points which Dr. Sheehan men- 
tioned to rae in regard to Acute Rheumatism, or Rheumatic Fever. That is. 
the higher the fever, and the more it shifts about from joint to joint, the more 
liable the fever is to go to the heart. There is greater danger then of it attack- 
ing the heart. The other one is that as long as the alkalinity of the uiine is 
retained, the heart is not so liable to be attacked. 

This is a painful inflammation of one or more joints, running a chronic 
course. Two forms are described by Raue; one in which some single joint re- 
mains chronically stiff and painful; the bones crepitate at the joint upon mo- 
tion being made by the operator; the joint may be swollen, or the swelling may 
be lacking, or only apparent, through the atrophy of the surrounding muscles. 

The second form is merely repeated attacks of rheumatism. The patient 
is very sensitive to changes in the weather, and can often foretell them by 
pains in his affected joints. This form is often complicated by rheumatic neu- 
ralgia or paralysis. 

Aetiology. — The causes are mainly the same as for the acute form; hered- 
ity, exposure, mental depression, poverty and physical exhaustion. The dis- 
ease attacks mostly persons in middle life or in advanced age. 

Pathology: — The ligaments and synovial membranes are thickened, enlarg- 
ing the joint; the bones have become spongiform at the cartilaginous ends, and 
the synovial fluid is turbid. Very commonly the joints are enlarged and de- 
formed There is hyperaemia and effusion in the tissues about the joint. 

While the disease in many cases is the result of the acute form, it may at- 
tack one independently of previous illness. Quain states that in some instances, 
one member of a family is affected by the chronic form, while brothers and 
sisters suffer from acute rheumatism. 

Symptoms'. — The most marked svmptom is pain and stiffness of certain joints, 
aggravated by bad weather, and becoming most severe at night. The affected 
joints are dry and stiff, and crepitate upon movement. Rubbing and exposure of 
the joint to cold atmosphere lessen the pain, but increase of warmth aggravate 
it. 

This form of Rheumatism varies much with individuals, some are affected 
with stiffness and pain in some single joint. The joint does not seem to have 
undergone structural change, and the patient may have good general health, 
leading an active and vigorous life. Other cases present more severe symp- 
toms. The pain in the joint is greater, anatomical changes have taken place 
in it, and it is red, painful and swollen. There are repeated attacks of sub- 
acute rheumatism. 

Still other case? present more marked symptoms of pain, swelling, etc. 
The changes in the joint are marked, the attacks are so frequent that the pa- 
tient is in almost constant pain. The joints are often ankylosed or dislocated. 



CHRONIC ARTICULAR RHEUMATISM. 35 

This disease often leads to permanent disability, but deaths from the disease 
directly are rare. 

Heart disease, as in the acute form, is a frequent complication. Dyspepsia, 
and the formation of calculi often occur. 

The Prognosis under Osteopathic treatment is good. In all cases relief can 
be given and in a certain number, entire relief from the symptoms is obtained. 
Medical prognosis for cure is very unfavorable 

Muscular Rheumatism'- —This form of Rheumatism differs considerably from 
the other forms described, on account of the different regions of the body in 
which it settles, attacking muscles, tendons, periosteum, neurilemma, fascia, and 
other fibrous structures, but never joints. It shows a tendency to attack cer- 
tain groups of muscles, causing varieties of Rheumatism, to which specific 
names have been given, e. g. Lumbago, Pleurodynia, Cephalodyuia, etc. It 
is frequently associated with other forms. This disease is characterized by 
pain and spasm in the part affecied, and by some fever. 

Aetiology: — A rheumatic diathesis is said to be the chief predisposing cause. 
It attacks one at any age, and of either sex. Exposure to cold, particularly 
to a draft upon a muscular part; strain of the muscles or ligaments, are the 
chief causes of an attack. 

Raue describes the pain of an attack of muscular rheumatism as, "tearing, 
shooting, stitching, screwing, burning; sometimes aggravated and sometimes 
relieved by motion, rest, cold or warm application, etc." Little is hnown as to 
the pathology of the disease. Sometimes fibrous growths are formed in the 
muscles, and the peripheral nerves are grown together, but usually there is no 
change discoverable in the muscular structures. Swelling and redness may be 
present or lacking. 

Symptoms: — Are slight fever, sore throat, pain in the muscles, which be- 
comes severe and spasmodic. The patient assumes characteristic attitudes to 
give ease to the parts. The tongue is furred, appetite is poor, constipation is 
present, also general malaise. Most of these symptoms may be wanting in any 
given case. 

This Rheumatism is not of long duration in many cases. It may disappear 
in a few days or weeks, or may remain as a chronic ailment, affecting the mus- 
cles of a particular part. It readily yields to Osteopathic treatment. 

The chief varieties are Rheumatic Tofticollis (stiff neck); affects the mus- 
cles, or the sterno-mastoid, drawing the head to one side, (wry neck." 

Lumbago:— k.^^oXxw'g chiefly elderly persons, coming on suddenly, the pa- 
tient, stooping over, finds himself unable to rise. It affects the lumbo-dorsal 
fascia, the erectors spinae, and smaller lumbar muscles. I remember one case 
of this disease in particular. I was called early one morning to go. see a :ady 
who had been sitting upon a chair and bending over her trunk, and when she 
went to arise she could not get up. When I got there I first relaxed the mus- 
cles ail along the lumbar region as l)est I could with her silting upon the chair. 
She was put in bed and I soon got the muscles all loosened. She was soon all 



36 TREATMENT OF RHEUMATISM. 

right again, and was about that daj^ and I did not hear of her being troubled 
afterward, although I lived in that neighborhood for some lime, 

Cephalodjmia: — Attacking the frontal, occipital, temporal muscle, the galea 
capitis, or periosteum of the skull. 

Dorsodynia: — Of the muscles of the upper part of the back and shoulders. 

Pleurolynia: — Of the fibro-niuscular structures of the chest, causing pain 
in the side, cough, restrained respiratory movements, in pectoral and intercos- 
tal muscles. 

Treatment: — Osteopathic treatment of Rheumatism must be persistent but 
not severe. There is danger in Acute Rheumatism of setting up fresh inflam- 
mation and driving the diseese to the heart, if too severe treatments are given. 
Hence m^^ great care. One should not treat too often or too long, especiall}' at 
the beginning of treatment. Three times per week is sufficiently often. Length 
of treatment should vary from ten to fifteen minutes, according to the case. 

Too frequent and prolonged treatments, as well as too severe handling are 
especially apt to irritate and do harm in Rheumatism, because of the soreness 
and pain that naturally accompany the complaint. 

In any ca^e of Rheumatism, the Osteopath must give especial attention to 
stimulation of the kidneys. He must also thoroughly treat the liver and boivels, 
stimulate lung action, and cutaneous circulation, all with a view of removing 
the acid from the system. The liver is said to be frequently enlarged in Rheu- 
matism. 

Dr. Harry vStill alwaj^s has good success in treating rheumatism, and his 
treatment upon the kidnej^s is invariabl)^ this already described to 3'OU as stim- 
ulation of the kidne3^s from the sixth dorsal to the second lumbar. Your work 
upon the liver and bowels is for the purpose of eradicating the poison from the 
system. You must also stimulate the twelfth dorsal and upper lumbar. You 
know how to stimulate the lungs from the second to the seventh dorsal on each 
side, also stimulate the second dorsal and fifth lumbar, centers for the superfi- 
cial fascia. A general spinal treatment is given, and bathing and as much ac- 
tive exercise as the patient can take are good. 

The treatment then for the liver, over the ribs from the eighth to the 
twelfth; kidneys, sixth dorsal to the second lumbar, also the twelfth dorsal and 
the upper lumbar; for the lungs, second to the seventh dorsal on each side, for 
the fascia, second dorsal and fifth lumbar; add to that, treatment to the superior 
cervical ganglion of the sympathetic, reaching the center for the medulla. 

I have seen Dr. Harry Still take a case of Rheumatism and for the first 
work do nothing but stimulate the bowels, kidneys and liver, and he would not 
go anj^ further. I have often wondered w^hy he should give such short treat- 
ments, but he is very successful in treating Rheumatism. The treatments are 
new to the patient and this is all that he can stand. You must gradually ex- 
tend your treatment to other parts of the body, since in the various forms of 
Rheumatism, the digestive and circulatory systems may be deranged, the heart 
and lungs, kidneys, and blood all undergo pathological alterations, and even 



TREATMENT OF RHEUMATISM. • 3| 

^"he braiu may be affected The Osteopath must keep close watch upon the 
condition, and by combining thorough general and spinal treatment with the 
specific measures he employs, keep the system and their special parts and or- 
gans well stimulated and sustained. He may thus prevent or repair these 
pathological changes, aborting the attack, or giving grateful relief. 

In the articular forms, the object of treatment is to spread the Joint and 
give free access of blood and nerve flow. There are particular ways It is 
w^eli to work the arm up and around. But it does not reach as well as a par- 
ticular move, taking the arm of the patient in one hand I double the other 
hand and place it in the axilla. I then push the arm of the patient down close 
to the side; that springs the shoulder joint, allowing the articular nerves and 
vessels free action. If it be in the spine, this movement of traction 
that I have shown frequentlv is good or with the patient sitting 
with the hips held down, while you reach down and lift at various 
points along the spine, thus spreading. For the knee and ankle, 
you can have some one hold under the shoulder while you pull, in this way^ 
while spreading the joints of the knee and ankle. Another way that I 
have for treating the knee is to place the foot of the patient between my knees 
and to work in the popliteal space, holding the knee in this way and spreading 
the hamstring muscles. Another very good way is to have the patient sitting 
upon a chair, place your knee under that of the patient so that his popliteal 
space rests upon your knee and you can spread the joint by pushing the leg 
downward. As to the wrist and fingers, you can by holding the forearm in 
one hand, spread the wrist joint and the fingers, by traction. At the elbow I 
have the forearm semi-fiexed upon the arm and that releases the olecrannon 
process and you can spread the joint by traction at the bent elbow. This 
motion will apply, I think, to all of the joints of the body, so that you will 
have no difficulty. When there is motion in the joint and the synovial mem- 
brane is not destroyed, the chances of restoring it are good. You cannot tell 
from the outside how much of the joint has been destroyed. You can only tell 
by general symptoms, by the amount of motion and the amount of pain, judg- 
ing from these that the synovial membrane has not been destroyed. Then you 
have a great deal better success than if the membrane has been destroyed. 
Spreading, as I have said, renews blood and nerve supply and absorbs deposits, 
but it will take many months. You must have the patients treating for month 
after month. A great many people do not have the patience, even if they pos- 
sess the means, to continue the treatment long enotigh to get the results. If 
people possessed the patience to contmue the treatment a sufficient length of 
time, we could do so much more good than we can under other conditions. 

In Actite Rheumatism great care must be taken in spreading, on account 
of the pain. The same is true to a considerable extent in the chronic forms. 
You must gradually accustom the patient to the treatment so that he can btand 
a great deal more. 

In Muscular Rheumatism, the treatment must be directed to stretching 



^S TREATSIICNT OF RHEtrivrATISM. 

and thoroughly kneading the affected muscle, tendon or joint. I lay special 
stress upon stretching the muscles. If yon have, say the biceps muscles of the 
arm affected, I would adopt some such motion as this: push the arm ont 
straight and back, the idea being to increase the distance between the bony at- 
tachments so as to stretch the muscles. Get the best w^ay to stretch and 
elongate the mu'"cle itself. Owing to the elasticity of the muscles they may be 
stretched, allowing free flow of blood through them. You can also knead 
5ome, and you can prescribe baths. A salt rub is good. Massage treatment 
will not be a bad thing with the idea of loosening up the blood flow, taking 
away the congested condition; but we do not depend much upon this massage, 
the principal treatment being to knearl the muscles and to stretch them. I 
believe there is a theory that the specific poison is retained in the diseased part, 
so that by throwing more blood to the part and by stimulating that region it 
helps to carry away and throw off the poison. 

The Osteopath must aUvays trace the nerve supply of the affected parts 
and look for lesion to the nerve or centers. In sciatic rheumatism, in rheu- 
matism of the arms, I have found distant lesions along the spine. Within the 
last month, as I remember it now, I have had four different cases in which 
there was rheumatism in one or both aruis, and in each one of these cases I 
have found some slip of the vertebrse in the upper part of the dorsal region, 
this being the region that seemed to be most involved, while in the sciatica nd 
in the lumbago you wiU often find slips or lesions along the spine. You will 
find that it is a part of our system, this finding of special lesions, as I under- 
stand it, though perhaps not entirely. When you find such lesions, although 
you may not be able to directly connect them with <"he disease, you must be 
able to trace indirectly in this way. 

In lumbago there is a direct lesion to the nerves of the lower spinal mus- 
cles. I have found that the best way to treat this is with the patient sitting 
upon a chair. This is the same treatment thnt I have shown for other things, 
that is for stretching the joints of the spine. I work here particularly along 
the lumbar region, lifting and turning as I go, with the idea of loosening these 
muscles and correcting any slip which may have occurred. 

Besides the points already mentioned, heat and rest are valuable adjuncts 
to the Osteopathic treatment. 

Acu/e:~~ln the fevered stage of Rheumatism, the cold baths, cold pack, 
and sponging with tepid water are beneficial . 

The patient should be placed in bed between blankets, which absorb pers- 
piration and prevent the chill of damp linen. Rest for the affected joint is sup- 
plied by wrapping it in cotton, wool or other soft-, warm material. Warm fo- 
mentations give relief when applied to the joint. As far as possible we move 
the joint, especially in the chronic forms. The joint is placed at rest entirely 
in this acute form but if it is kept there too long it may become ankylosed. If 
you keep up motion to the greatest extent possible you will be able to get bet- 
ter results. I have not known of a case which was followed out by Osteopathic 



INFLUKNZA, CATARRH AND COI^DS. 39 

treatment where the joint was left stiff. It is a matter of judgment as to how 
far to work the joint. 

In chronic forms warm clothing and housing, protection, from climate, 
relief from toil and muscular exertion, turkish baths, warm or hot fomenta- 
tions applied to the joints, followed by vigorous rubbing are valuable aids in 
Osteopathic treatment. 

In muscular rheumatism the same general plan of treatment ma}^ be fol- 
lowed. 

It should be borne in mind that these various adjuncts may not be neces- 
sary except in severe and stubborn cases. If the simple Osteopathic treat- 
ment is sufficient you will not need to be bothered with these other things. 



LKCTURE VIII. 

Mfluenza, Catarrh a?id Colds: — These three maladies are somewhat similar 
in pathology. They frequently are presented to the Osteopath for treatment, 
and such treatment is, as a rule, in the highest degree successful. 

The treatment for inAuenza, and for the condition commonly known as 
cold are almost identical, while that for catarrh is as far as it goes, similar. 
Hence these subjects may be conveniently considered in the same lecture. The 
fact that all may depend upon the same agency for their production, at least to 
some extent, namely exposure, and the fact that in all the main pathological 
facts are the congestion of the blood in certain parts of the body, the tightening 
of the muscles and ligaments, and the aberation of nerve function consequent 
to these conditions, make them especially interesting to the Osteopath, and 
especially amenable to his treatment. 

Infhieyiza, commonly known as LaGrippe, called also, Catarrhal Fever and 
Epidemic Catarrh, is described as an acute, infectious, epidemic disease, marked 
by febrile symptoms, and usually complicated with other serious affections, 
being followed by sequelae that are frequently distressing and severe in a 
marked degree, such as progressive muscular, atrophy, various forms of par- 
alysis and spinal trouble, etc. There is one patient here at present suffering 
from Locomotor Ataxia and progressive muscular atrophy. He tells me that 
he had four or five different attacks of influenza. I think that his disease may 
have developed from these repeated attacks of influenza with the attending ner- 
vous symptoms, leading to these serious results. It is not at all surprising 
that such serious results should follow, when 3^ou come to consider that these 
nervous disturbances reach far enough to alter the sta^e of nerve centers to a 
very marked degree. 

As a rule this distressing malady occurs epidemically on a grand scale, 
though it may also occur endemicall}^, and occasionally, sporadically. Usually 
vast areas, such as whole countries, are successively invaded by the epidemic. 
Epidemics are recorded as early as 1729. 

Its manifestations are varied, different epidemics seeming to possess differ- 



40 INFLUKNZA, CATARRH AND COLDS. 

ent marked characteristics, but three different general forms have been 
described: 

(i) Simple, without serious complications. (Catarrhal.) This form 
attacks particularly the membranes of the respiratory Tract. 

(2) Thoracic, involving the tho:aclc viscera, and complicated with such 
affections as pneumonia, bronchitis, etc. 

(3) Abdominal or Gastro-Iatestinal, affecting the digestive organs. I 
will mention one fact here, lest I forget it when speaking of colds. I have 
known people to have a severe attack of intestinal cramping, accompanied with 
constipation or diarrhoea and severe colic — symptoms arise from what I believe 
to be taking cold in the abdomen. Thf^y in some way get the abdomen ex- 
posed perhaps b>^a change of clothing, which would cause the cold to settle in 
the abdomen without necessarily being felt elsewhere. This, I think, will be 
a valuable suggestion to you, although I have not read it in books but have 
heard others speak of it. 

(4) To these has been fittingly added, the Neural or Cerebral type, 
attacking the nervous system, often simulating the clinical course of Typhoid 
fever, as does sometimes the Intestinal type. 

It is stated that these various types may all be seen in the same family in 
which several members may be suffering. 

Clinical Features: — The onset is, as a rule, very sudden. The patient may 
note the first symptoms upon rising from bed in the morning, upon 'rising after 
sitting, or when about his daily tasks, having a few moments previously felt 
entirely well. It usually manifests itself first by a chill, followed by a fever, 
loss of appetite, headache, lassitude, aching and soreness of the back, limbs, 
and muscles, profound mental and physical depression, catarrhal inflammation 
of the nasal mucous membrane, etc. This malady may affect persons of any 
age, sex, or occupation. Pulse slow; con'^tipation; temperature irregular to 
high; urine scanty and high colored or profuse and light colored. 

Catai'rhal Type- — Dryt^css of the nostrils, sore throat, sneezing, watering 
of the eyes, difficulty of swallowing and of breathing and pains in the eyeballs 
are present. These symptoms may remit during the day, increasing at night. 
The tongue is moist and coated with a creamy fur, the pulse is frequent. (80- 
100) Diarrhoea is often a symptom, ab well as inflammation of the ear. 

Thoracic Type: — In this form, in addition to the usual symptoms, are seen 
pneumonia, bronchitis, pleuritis, quinzy, and infiltration of the lung. All the 
prominent symptoms are concerned with the thoracic viscera. A peculiarity of. 
the Bronchitis is the general inflated condition of the lung, which, instead of 
collapsing upon opening the thoracic cavity, protrudes from the aperture. 

G astro- Intestinal Type: — Soreness of the abdomen, biliousness, nausea, 
vomiting, sometimes jaundice, diarrhoea, etc., are prominent symptoms, in ad- 
dition to the general symptoms named above. 

Cerebral Type: The nervous symptoms predominate. Headache, delirium, 
tinnitus aurium, muscular twitching and hyperaesthesia are all noted. 



INFUENZA, CATARRH AND COLDS. 4! 

Infhienza is of variable duration in length of time of the attack. It may 
disappear in forty-eight hours, or it may remain acute for several weeks. Often 
it subsides into a semi-chronic state, and keeps the suiTerer miserable for 
months. It seems to attack the weak points in the system, and to develop 
latent morbid processes already present. It is not usually of itself fatal, but 
causes death in a fair average of cases through some complication or sequel. 
The Bronchitis of Influenza seems to be the most fatal. 

A serious feature of this disease is the sequelae in leaves. The mental or 
physical depression often persist after the acute attack, hypochondria, tubercu- 
losis and paralysis frequently supervene. The poison left in the syslem has, 
according to Gowers, a peculiar liability to afiect the nervous system. Hence 
the nervous sequelae, both from their nature and frequency, are the mo t 
marked of the after effects. Mental dullness, melancholia, and delirium; the 
general paralysis of the insane; hysteria, cataleptoid and epileptic seizures; 
neuritis and affections of nerve centers, are all amongnervous sequelae of Influ- 
enza noied by Gowers. 

Aetiology: — Little is known definitely concerning the cause of this disease. 
Some writers have suggested an atmospheric influence, as well as the effect of 
bad drainage and poor sanitation, as being the cause. It seems probable that 
the true aetiological factor is a microbe discovered by Pfeiffer, Kitasato and 
Canon in 1892. 

Catarrh: — Catarrh, Coryza, or cold in the head, is an inflammation of the 
nasal mucous membranes, with increased secretions from them. 

The term Catarrh is used in a general sense in describing the inflammation 
of any mucous membrane in the body, Thus there is Catarrh of the stomach, 
Intestinal Catarrh, Catarrh of the bladder, etc. The term Coryza is usually 
employed to designate Catarrh of the nasal membranes. 

Symptoms mid Aetiology: — Catarrh is brought on by exposure, by too sud- 
den cooling of the body when heated, or by sudden lowering of the tempera- 
ture. It occurs sporadically, sometimes epidemically and one attack predis- 
poses to another. It is sometimes caused by inhalation of irritating gases, such 
as chlorine, etc. It is stated by Raue that epidemics seem to depend upon a 
peculiar unknown condition of the atmosphere, probably deficiency or super- 
abundance of ozone. You will also find frequently that the contraction of 
muscles has drawn the vertebrae out of place. This, frequently has been 
found to be the case by our practitioners, and there does not seem to be any 
reason for doubting that the vertebrae may be drawn out of place, as queer as 
it may seem, by contraction of the muscles. I have had cases of trouble in 
the neck where the vertebrae, one or nice, was displaced. It is often the sec- 
ond or third, I have often found when I had replaced a vertebra that the ef- 
fect of a cold was to draw it out. I will say that such may not be the case ex- 
cept in cases where there has been a previous accident, causing a displacement 
of the vertebra, but I am convinced from my observation that a vertebra may 
be drawn out by overdue contraction of a muscle. And from the standpoint of 



42 Influenza, Catarrh and Colds. 

Osteopathy this disease may be caused by some faulty condition in the anatomy 
of the neck, contractions of the deep muscles, or displacement of cervical ver- 
tebrae, usually of the second or third, which interferes with blood and nerve 
supply of the nasal mucous membrane by shutting down upon the jugular 
veins, thus preventing venous return, or by affecting nerves coutrollmg the 
blood flow, thus disarranging it. These conditions either weaken the mem- 
branes and leave them susceptible to the influence of th. ordinary aetiological 
factors, or they cause a congested and inflamed condition of these parts, at- 
tended with ihe increased secretions characteristic of catarrh. 

The Syjnptoms are chilliness, headache, indisposition, sneezing, dryness of 
the nose and throat, etc. 

The inflammation extends into the frontal sinuses, into the antrums of 
Highmore through the nasal duct to the lachrymal sac, causing conjunctivitis; 
or into the Eustachian tubes, affecting the ears. The inflammation may also 
extend from the mucous membrane into the skin of the nose, or down into the 
bronchi, causing lung troubles. 

The catarrh is described as serous, mucous, or muco-purulent according 
to the nature of the secretion. The first secretion is thin and watery, the 
second is thick, a copious discharge of mucous; the third is composed largely 
of leucocytes, and partakes of the nature of pus 

This latter discharge may, in chronic cases, decompose in the nasal cavi- 
ties or in the sinuses and become extremely offensive. 

Colds: — A cold, regarded by some writers as a nervous disturbance, is 
usually considered as a congestion of the blood in the vessels in some part or 
parts of the body, brought on by exposure in some form. Coryza is a cold in 
the head. 

Aetiology. — Cooled surface of the body and closed pores, drives the blood 
inward; increases the work of the lungs, and causes it to congest at weak spots; 
exposure to the cold or damp, e. g. getting the feet wet, sudden cooling of the 
body when heated; sitting or standing in a draft; living in overheated quarters; 
sleeping undei too heavy covers, and wearing of too warm clothing, thus 
causing the body to become tender, are among the usual causes of catching 
cold. I have known people who were foolish enough to suppose that by keep- 
ing in doors all the winter they would be free from colds and it is almost in- 
variably the case that they will have a cold much of the time. Thev stay-in 
warm rooms and sleep under too warm covering and the body becomes tender. 
Coming suddenly from very cold temperature into very warm, as from out 
doors into a super-heated room, will give a person a cold as quickly as t3 go 
from a heated room out into the cold. The system is not always able to ac- 
commodate itself to such sudden changes of temperature. 

Symptoms are similar to those noted in Catarrh, namely: chilly sensations, 
discharge from the nasal mucous membranes, headache, light hemorrhage from 
the nose, soreness and stiffness of the muscles, etc. 

One attack predisposes to another. The patient frequently falls into a 



TREATMENT OF CATARRH, COLDS AND INFLUENZA 43 

semi-chronic condition, continually taking more cold and seldom being without 
one. This is likely to happen on account of the deranged circulation, the 
patient frequently breaking out into a perspiration with slight exertion, this 
being followed by further chilling and fresh symptoms of a cold. A cold, if 
severe, may have severe complications; pneumonia, bronchitis, influenza, etc. 
Treatjuent, {heat) ; — The drinking of hot lemonade, hot foot baths espec- 
ially upon retiring, or wrapping up well in a dry blanket to produce copious 
perspiration are usually enough to reduce a cold at first. It is said that if a 
cold is treated this way vigorously within twenty-four hours you can reduce it. 
These things should be used at night, and additional clothing should be put on 
next day as the system is weakened from perspiration, and care should be taken 
not to take more cold. Some would prescribe dry heat instead of moist. 
Heating of the feet before a fire is a good thing and does not open the pores in 
the way that hot water does, so if it is in day time when you cannot take the 
care you would like, this application of dry heat is perhaps a good remedy at 
first. 

Influenza: — I give the patient a thorough spinal treatment. I had a case 
of cold to treat this morning and I gave the same treatment that I give for in- 
fluenza. With the patient upon the face thoroughly loosen all the muscles 
and thoroughly stimulate the whole spine. The theory you already know. If 
I could not work enough with the patient upon his face I would turn him over 
and thoroughly stimulate the lungs, kidneys, liver and fascia in such a way as 
to work off the effects of the disease. That, in cold or influenza, is the partic- 
ular Osteopathic treatment. For the lungs the second to the seventh dorsal 
vertebra; kidneys, lower splanchnics; liver, at the abdomen, from the eighth 
to the twelfth ribs on the right side, raising the ribs, working in the right and 
left iliac fossae to reach the hypogastric plexuses and deep over the solar plex- 
us. Guard against the possible settling of a cold or influenza at these points, 
also attend to the fascia at the second dorsal and fifth lumbar. That is, include 
these points in your spinal treatment. 

Should the influenza have settled in the abdomen, give a thorough abdom- 
inal treatment, embodying the points already given. I would also give an 
enema in such a case to relieve the bowels of fresh congestion. I would treat 
the spine especially from the middle dorsal down, and all these plexuses of 
nerves through the center to the abdomen. 

For Cerebral Influenza I would look particularly for any condition of con- 
traction of the muscles along the spine. I first look for any contractures of 
the muscles in the neck. It seems to me from my experience there is always 
a contraction of the muscles of the neck although the cold may be elsewhere. 
It may be settled in the chest or some other part of the body but there will al- 
most always be a contraction of the muscles of the neck. I do not know that 
lever found a cold where there was not this marked condition of contraction of 
the muscles See whether or not there be any displacement of the vertebrae; 
the contraction of the muscles is very apt to bring on such a condition. In my 



44 TREATMENT OF CATARRH. 

experience in order to fiud out whether or not there is displacement of a verte- 
bra, I stand in behind the head and turn it from side to side, getting in deep 
to find if there be any displaced vertebra. In several cases where I knew there 
was trouble in the neck, I could not tell by standing at the side where the ver- 
tebra was out. When you are w^orking on a patient in bed as you may be 
sometime, bear this in mind, to get the patient in such a position that you can 
go to the top of the head. Of course when there are these cerebral symptoms, 
and the trouble is especially in the head you must treat the spine, equalizing 
the circulation, and sending the blood elsewhere. 

In Catarrh as well as in cold we would first thoroughly loosen the muscles 
about the neck, especially about the sides and back of the neck, also the styloid 
and hyoid muscles. Take the muscles which are attached to the styloid 
process and thoroughly relax them. A good treatment for catarrh is to hold 
under the lower jaw and have the patient spring the mouth wide open, you rub 
the muscles w^ell on each side and thoroughly relax them. Stand at the side 
and Dress in deeply at the styloid process wnth the idea of loosening up these 
mu'^cles and freeing the flow of blood through the carotid artery. Dr. Harry 
Still uses this treatment in almost every case, (and sometimes almost exclus- 
ively) of catarrh and troubles with the eyes and ears. He will have the patient 
open his mouth five or six times, and he assists the patient all he can by open- 
ing his own mouth at the same time. Now particularly in catarrh you wull find 
the second and third vertebrae are apt to be deviated to one side or the other. 
Of course we treat here at the upper part of the neck, and reach the superior 
cervical ganglion, thus influencing, through the sympathetic plexus, the dif- 
ferent parts of the brain, and through these nerves the sub and great occipitals, 
thus reaching the medulla w^hich you know contains the vaso-motor center, 
thus influence the general circulation of the body. It is important to work 
down along the spine to get the stimulating effect and the distribution of the 
blood flow. Also treat all these points of the fifth nerve, at the supra-orbital, 
the infra orbital and the mental foramina. Have the patient open the mouth 
wide, push the finger into the glenoid fossa, and have the patient close his 
mouth, that will have the effect of loosening the ligaments, and, it is claimed, 
affects the fifth nerne. We also reach the fifth nerve through its connections 
sympathetically by working upon the sub and great occipital nerves. I also in 
addition to thifi always thrust my finger behind the clavicles, thus raising the 
clavicles and stimulating the flow of blood in that way. Another treatment 
is to have the patient lie upon his back, and with the mouth open, I place the 
finger against ^he hard palate and work from side to side, in this way, back 
along the soft palate, uvulva and pillars of the fauces. 

I am treating a case at present in which the tonsils are chronically enlarg- 
ed and the uvulva is over one half an inch in length. These internal treat- 
ments reach that condition much better than any treatments I have been able 
to give, In this connection, you will often have a patient with a little hacking 
cough, most frequent in children: if you will look into the throat you will find 



TREATMENT OF COI.DS. 45 

that the condition of the soft palate is causing just enough irritation to keep up 
this little cough. By this internal treatment and treatment in the neck you 
will be able to stop the cough. I have another case which is rather peculiar, 
in which the mucous membrane of the throat is congested. There is an irri- 
tation of the throat which is dry and scales off in great dry flakes, sometimes 
blood mixed in it. It is peculiar in being so dry. I have treated a case in the 
way indicated to you, especially the styloid and hyoid muscles, quite hard. It 
will not hurt usually to work hard, but that you can determine by the condi- 
tion of your patient. I thoroughly relaxed in this way, and the lady who be- 
fore had to have water by her bed at night and frequently during the day, is 
very much better. Also in a cold we treat the sides of the nose, working from 
the lachrymal duct down. It seems to stimulate the nerves here and the flow 
of blood, freeing the membrane very well. We can free very nicely by work- 
ing down the nose in this way. This is on the same principle that our mothers, 
used to grease our noses with goose grease. 'For a stoppage of the nostrils and 
difficulty in breathing here is a motion that we employ with very good success. 
It is best to have a pillow. Lay the palm of the hand flat, press down hard at 
the frontal region, and you can bring a great deal of pressure in this way. I do 
not know what the nerve connection is, but a great many cases of nostril stop- 
page will be relieved in this way. Of course, work all about the eyes and loos- 
en all about the face to relieve the congested condition. 

Now I might explain to you my particular method of treatiiig a cold. I 
have bim lie upon the back, and I raise all the ribs and stimulate the lungs 
very briskly, on either side from the second to the seventh dorsal. I am work- 
ing from the middle dorsal above, as low as the twelfth dorsal, successively, 
having my hands against the angles of the ribs, and raising them as I go very 
briskly and very energetically. This is a great stimulation of the lungs as 
well as of the circulation throughout the body. I then bend the arm, this will 
vStretch the muscles over the chest and raise the upper ribs, then I raise these 
upper ribs by pushing the arm up and working under the clavicle. 

I frequentl}^ have been able, by this treatmeut, to relieve heavy colds in 
one treatment. If you can always do that you will be ver}^ fortunate. Of 
course I give a brisk and thorough treatment to the neck as well, and some- 
times it is the best thing you can do for the patient to thoroughly loosen the 
neck. 

If in any of these troubles there is a development of any special symptoms 
of course you must attend to these symptoms at once. 

Q. Do you think it is necessary to remove the tonsils? 

A. It is often done. I do not think it is necessary if we get the case in 
time. As to whether it is ever necessary, I presume it is. Sometimes they 
grow again and sometimes they do not. 

Q. Do you give the same treatment for dry catarrh that you do for moist 
catarrh ? 

A. Yes sir. 



46 CONSTIPATION. 

Q. What would 5^011 do in case of croup. Could you give immediate re- 
lief? 

A. I should work the neck through. I have been able by that treat- 
ment to give immediate relief. I would work all about the throat and neck. 
The trouble in giving treatment for croup is that it is generally found in little 
.children who object to such treatment. 

(Q. Would you use salt water? 

-A. Yes, sir, that is very good. 

Q. What would you do in membranous croup? 

A. You must be very careful in cases of membranous croup. Cause the 
patient to throw up. Thrust the finger down the throat and get the membrane 
in that way. If the membrane is far it will take very prompt action. Thor- 
oughly treat about the throat to keep the circulation free and prevent the form- 
ing of the membrane. 

Q. In catarrh of the throat would you give internal treatments? 

A. Yes. sir, it is well to treat inside. 

Q. How often would you treat catarrh? 

A. I would treat it three times a week. That will be sufficient. 

Q. Would you treat internally that often? 

A. No, sir, I w^ould not treat internally oftener than once a week, or 
once in ten days, unless in severe cases. 

In regard to colds, I have had cases where the cold was chronic and the 
condition of the system was weakened, in which I got good results by directing 
the patient to take a cold bath every morning. The brisk rubbing stimulates 
the circulation; not only does it stimulate the circulation, but it has a good ef- 
fect on the nervous system, stimulating and strengthening the pores of the 
skin so that they can more readily open and close and accommodate them- 
selves to the changes in temperature. 

LECTURE IX. 

CONSTIPATION. 

Constipation is defined as "infrequent or incomplete alvine evacuation, 
leading to retention of feces." — Quain. 

With this, one of the most annoying, as well one of the most frequent ills 
to which mankind is heir. Osteopathy has had most unqualified success. The 
ordinary sluggishness of the bowelss that affects so many people is speedil}^ re- 
lieved, ordinary constipation yields almost as readily, while some very marked 
and obstinate cases of years standing have been cured. I have known 
of a lady about thirty-five years of age constipated from birth, hav- 
ing never had a natural bowel action, to be entirely cured in six 
month's treatment. I have been told by one of our students who 
went out practicing in the summer, that he had a case of a lady older 
than that, a lady eighty years of age who had never had a natural action of 



CONSTIPATION. 47 

the bowels, whose case yielded to Osteopathic treatment. There are others as 
remarkable. Osteopethy seldom fails to cure constipation arising from the 
usual causes. Paral3^sis of the bowels, as seen in some cases of spinal disease, 
and in general paralypis, can be handled successfully only in such cases as will 
yield in regard to the general paralytic symptoms. 

In the matter of bowel evacuation, each indiv^idual's habit is a law un- 
to himself. Some people are not well without two motions daily, others in 
perfect health, go as long as three days. Raue states that he has known women 
in perfect health to have but one evacuation per week. As a rule, one evacu- 
ation per diem is necessary to health. But it must be borne in mind that the 
daily evacuation is not conclusive evidence of non-retention of fecal matter. 
The quantity of the motion may be insufficient. Cases have been noted in 
which the w^alls and sacculi of the colon were impacted with old remnants, 
while a regular daily stool, normal in consistence and color, was made, passina: 
thus through a channel whose walls were formed of old and hardened fecal 
masses. You will find in the retention of the fecal matter that there is an irri- 
tation of the bowel wall and a catarrhal condition arising from this irritation, 
hence it is that quite often there is an alternate constipated and diarrhoeal con- 
dition. The patient will have constipation for awdiile and diarrhoea for awhile. 
Dr. Hrrry Still tells us that he has found in his experience that if the liver is 
exceedingly tender, and he asks the question, "Are you not alternately troub- 
led with constipation and a diarrhoea condition?" the answer is usually yes. 

Symptoms: — The head is dull and the brain lacks vigor, there may be 
headache, dizziness, palpitation of the heart, etc, There is often too free se- 
cretion of saliva; the appetite is increased or lessened. There is frequent bil- 
iousness, pain in the bowels and upon defecaction, coldness of the extremities, 
backache, pains in the lower limbs, etc. The memory is poor, the head con- 
fused, the complexion sallow, and the breath bad. On the other hand, people 
with rosy complexions and every appearance of health may be chronic sufferers. 
Constipation is a symptom in a great number of diseases. 

Aeitology: — General and Local: 

General: — The causes of constipation are exceedingly numerous and varied. 
Too concentrated a diet, e g. milk, by leaving too little residue to act as an irri- 
tant to the bowel wall, stimulating it to action, becomes a cause The same is 
true of too rich foods. Laziness, late hours in bed, and neglect of the regular 
hour are all causes. I have a patient who \vill be constipated every time sh- 
oversleeps, and remains long in bed, simply because she has gone past the reg- 
ular hour. I think this is a cause with men in business who do not 
take time to attend to the regular calls of nature. This is one of the most ser- 
ious causes of the most obstinate cases of constipation you will meet. 

In hereditary cases, the factors are weak bowel muscles and nerve supply. 
Robinson instances a case in which he says he was satisfied that the plexus of 
nerves, the inferior mesenteric ganglion w^as not sufficiently developed, and he 
went to w^ork by proper exercises, horse back riding, etc., to develop the gang- 



48 CONSTIPATION. 

lion. The child had inherited weak bowel walls and a weak ganglion. Weak- 
ened muscles result from anemia, etc. lyoss of the fluids of the body, as in 
lactation, profuse sweating, and after diarrhcea, in diabetes mellitus, etc., may 
frequently be causes. You must have a normal amount of fluid in the sys- 
tem. I have found cases in which a certain amount of water had to be prescrib- 
ed daily in order for the patient to drink enough. Often the physician has to 
prescribe some sort of table water to get enough fluid into the system. Often I 
prescribe water to be taken in the morning before breakfast, not at breakfast 
but fifteen minutes or a half hour before. 

The use of foods leaving coarse, dry residue, e. g., corn and beans; the use 
of strong purgative medicines, etc., and any cause lessening peristaltic action 
of the bowels may cause constipation. People frequentl}^ take a tea spoon full 
of salt in the morning, washing it down with a cup of water. It will do all 
right for awhile, but it will dry the bowel, and the powerful action of the salt 
exhausts the blood vessels supplying the bowel, so always discourage the use 
of salt by a patient. 

The styptic quality of the tannin contained in tea acts as a constipator by 
lessening their secretions. Lessen, or change in the quality of the bowel secre- 
tions and the secretions of the liver and pancreas, cause constipation by robbing 
the bowel of the stimulus gained from the action of these fluids upon the 
nerve terminals. 

Too great muscular activity, nervousness, excessive mental application^ 
are all aetiological factors. 

Among the /^<fa/ causes may be mentioned mechanical agents, e. g., a dis- 
placed coccyx, a tightened sphincter ani muscle, pressure of a pelvic tumor, or 
of a gravid or misplaced uterus, impactions of the colon, stricture from peri- 
toneal adhesion or hernia; mechanical stoppage by the presence oi foreign bod- 
ies like grape seeds, fruit stones, etc. When you have peritoneal adhesion you 
may have a serious case, because that may progress enough to stop the bowel 
entirel3^ 

Osteopathic Theory: — Mechanical causes aside, the Osteopathic theory in 
regard to constipation is that some lesion to the spine prevt^nts proper action of 
the innervation or of the blood flow of the bowel, leaving it weak and ready to 
yield to any of the above mentioned general causes of constipation. Auer- 
bach's plexus, ruling bowel motion, and Meissner's plexus, ruling bowel secre- 
tion are intimately connected with the sympathetics of the abdomen. These 
sympathetics may be hindered in action by some spinal obstruction of a nature 
and in a manner previously designed. Thus either secretion, or motion, or 
both, may be affected and constipation result. Or, since the blood flow is un- 
der control of the sympathetics, the lesion may readil}^ affect it and cause the 
trouble. Hare (^Practical Therapeutics p. 489) says "experiments have shown 
that the circulation of the blood through the intestines greatly influence peris- 
talsis, and disorders in the blood supply readily bring on intestinal disorder." 
He also says that "peristalsis is almost entirely a reflex action, dej^ending for 



CONSTIPATION. 49 

its existence upon the integrity of the nervous plexuses in the intestinal walls, 
namely those of Auerbach and Meissner." Hence effects upon these plexuses 
by lesion of their sympathetic connections might be of such a nature as to re- 
sult in constipation. 

It is evident that lesion to the spine anywhere in the splanchnic area, fifth 
to the twelfth dorsal, or below, might be the cause of constipation, but Osteo- 
pathic practice has designated certain important points in the spine at which 
lesion is likely to be followed by constipation. Such are the second lumbar, 
fourth and fifth lumbar and fifth sacral. The latter point is significant because 
the fifth sacral nerve controls the spinchter ani muscle, and lesion of it may so 
affect the nerve as to cause undue contraction of the spincter. and thus act as 
a mechanical cause of constipation. 

Lesions of the splanchnics or solar plexus, affecting the liver and the pan- 
creas and their secretions, also become a cause of constipation. 

Byron Robinson has lately written (Medical Brief) very clearly upon con- 
stipation as a neurosis of the the fecal reservoir, as he calls the left half of the 
transverse colon, the de.-cending colon and the sigmoid flexure. He makes a 
very interesting point there, that the small intestine and large intestine, (the 
ascending half of the transverse part) are subject to a quicker rythmatic action 
from their innervation than is the remaining part of the bowel, which is descri- 
bed as the fecal reservoir. 

This portion of the colon is under control of the inferior mesenteric gang- 
lion situated upon the inferior mesenteric artery, and sending its branches to 
the intestines. Muscular atrophy of the bowel walls must be referred to the 
nerves, since they control the lumen of the blood vessels. 

The abdominal brain may be abnormally small in some persons, be under 
developed and thus allow of insufficient bowel action. 

Neurasthenia, also deficient blood supply to the parenchymal ganglia of 
Auerbach's and Meissner's plexuses are frequent causes of constipation. In 
these cases of neurasthenia which you will meet, you wnll of course usually 
find constipation as a fa^^tor, and you will become able to recognize and ask at 
once if the patient has constipation. Simple observation is a great thing to 
put you on the right track. 

The movements of the intestines largely depend, he says, upon the amount 
of fresh blood sent tv"; these ganglia. Peristalsis, so far from being impaired in 
constipation, may be increased, but be in vain. 

A checked blood flow, or a lack of blood, as in anemia, becomes a cause. 

An empty bowel is a still one, a full bowel an active one. 

The irritation which increases peristalis may also narrow the lumen of the 
blood vessels, lessen secretions and cause constipation. 

In enteroptosis the w^eakened ligamentous portions of the omenta elongate 
and allow the organs, including the intestines and stomach to sink downward 
from their natural positions. This weakness of the ligaments begins from loss 
of tone in the abdominal sympathetics and you must as Osteopaths, as a rule, 



50 TRKA.TMKNT OF CONSTIPATION. 

refer that to lesions along the spine. I thi^k I have thoroughly explained 
that before. By the gravitation of the organs downward, the nerve plexuses 
and fibres are stretched and still further weakened. The enteroptosis allows of 
kinking of the colon, especially at the splenic and hepatic flexures, and be- 
comes thus a mechanical cause of constipation. It also interferes with the 
blood and nerve supply to the intestines, hinders muscular action, lessens se- 
cretion and absorption and thus becomes a prolific source of constipation and of 
■'other ills. 

Osteopathy also looks upon constipation as a "neurosis of the fecal reser- 
voir." It recognizes the importance of free blood supply to the muscles of the 
intestines that they may not atrophy, also of free supply ot blood to the paren- 
chymal ganglia situated within the walls of the intestines, that they may thus 
be stimulated to normal action. By affecting the sympathetic connections, by 
adjusting all abnormalities that may interfere with blood and nerve flow, Os- 
teopathy preserves the integrity of bowel action. 

It looks upon the weakness of the sympathetics that allows of enteroptosis 
and of its concomitant ills, as due to some spinal lesion which either directly or 
indirectly affects and weakens sympathetic life. I make that broad statement, 
of course I know as well as any one else that you do not always find spinal les- 
ions in constipation, but in general that is the explanation we give and in gen- 
eral that is correct. You may have torpid liver which may in itself be a 
cause for constipation. 

Excepting cases of constipation caused by mechanical agents, the system 
would not be subject to the operation of the general causes assigned for con- 
stipation, were spinal life perfectly adjusted and maintained. 

Treatment'. — It is divided into (a) upon the the spine; (b) upon the abdo- 
men; (d) upon the coccyx and local, and (e) adjuvants. 

A. The purpose of the former is to remove any lesion that may be inter- 
fering with sympathetic life or cerebro-spinal nerve life of the owel. You may 
have, of course, as you understand, some irritation along the spine which in- 
terferes with nerve life, so that when I examine in case of constipation I always 
look for a lesion. You may find affected in constipation the splanchnic area and 
the region below as far down as the sacral. All of these lesions I described in 
treating the spine. It may be a contracted muscle, a slip of a vertebra, some- 
thing which alters the curves of the spine, or any one of these lesions described. 
It may occur along the spine, so make examination in the areas mentioned. I 
come to the second lumbar and I often do not find it out of place. I believe I 
have already shown you the treatment for the second lumbar. Make the se- 
cond lumbar a fixed point, counting up from the sacrum below, then make it 
the fixed point by placing the thumb and doubled finger against it and push up 
against the thigh; then take the other hand at the same place and make a fixed 
point at the second lumbar while you raise the upper part of the body and work 
it around this fixed point, thus effectually loosening any contracture of the lig- 
aments. 



TREATMENT OF CONSTIPATION. 5I 

The third and fourth lumbar are particulary significant to us, and the fifth 
lumbar as well, since lesions there rr ay affect the hypogastric plexus and we 
work there especially to affect the lower hypogastric and pelvic plexuses. Do 
not forget to attend to the splanchnic area and all of the sympathetic connec- 
tions here with all of the nerve mechanism of the bowel. You know between 
the eighth and and ninth dorsal is the center given for the liver, so I always 
work along that region in constipation. I never stop my treatment for consti- 
pation without raising the eigth to twelfth ribs on the right side and usually it 
is after I have treated the liver, so with the patient on his back, I reach across, 
grasping the right arm of the patient with my right hand, and then raise and 
work up and back to raise the ribs. 

Why do we work upon, the liver? Because we wish to keep the flow of 
blood free. It seems that the bile is one of the best lubricants for the intes- 
tines and has a great deal to do with the normal stimulation. At the fifth sacral 
desensitize if you have any reason for supposing the sphincter ani is affected. O 
course you determine this by a digital examination. Note the first to fourth 
lumbar for the large intestines. Peristalis particularly at the ninth, tenth and 
eleventh dorsal, either by raising the lower ribs or by springing the spine and 
strengthening that region in the ordinary w^ay. 

B. The treatment over the abdomen. I work at the solar plexus in con- 
stipation. It is closely associated with the bowel at a point about midway be- 
tween the umbilicus and the ensiform appendix; by deep pressure in this region 
you can usually, by going slowly, bring considerable pressure upon that point. 
In people with bowel trouble, and in dyspeptics you will usually find it quite ten- 
der here. Do not be rough, but you can push in deeply and stimulate these cen- 
ters. Thus you reach important connections not only with the intestines but also 
with the liver. Also reach the hypogastric and pelvic plexuses by working 
along the third, fourth and fifth lumbar, and by working through the abdomen 
in front. 

Also, there is a mechanical work that we csn do along the line of the colon. 
Usually it is best to begin at the left in the region of the sigmoid flexure and 
work up to the ribs, then across above the umbilicus to the corresponding re- 
gion on the right, and on down to the right iliac fossa. You work along the 
line of the colon and get such mechanical effect, but as I said before, that is 
not the only effect we get, we stimulate the bowel walls, stimulating Auerb.-iCh's 
and Meissner's plexuses in the bowel wall, thus reaching the nerve suppl\-. and 
not so largely through mechanical action. Also, it is important to straighten 
the bowel and keep it free. We reach in deeply at the iliac fossa and straight- 
en out the sigmoid, work up against the course of the bowei and teiui to 
straighten it. You can sometimes obtain good results in swelling of the lower 
limbs by reaching in here deeply and raising the intestines, thus relieving the 
blood vessels. Now I always work upon the liver, that of course is one of the 
important points in constipation. Have the patient with the knees flexed and 
lying evenly disposed upon the table. Taking the left hand, I reach under the 



52 TREATMENT OF CONSTIPATION. 

edge of the right ribs against the edge of the liver. You must be careful not 
to bruise the liver. You can also get a squeezing motion upon the liver by 
reaching in below the right side and working on top of the ribs in front, and 
thus quite effectually pressing the liver. Then we work along the course of 
the bile duct. This is upon the right as you know, curved in the shape of a 
reversed S, so we work back along the S with the idea of freeing up. Some- 
times in catarrhl conditions you will have a mucous plug formed and the duct 
stopped. 

Also I stimulate the inferior Mesenteric ganglion by working the bowel a 
little below and to the left of the umbilicus. This is important, since as w^e 
see, this ganglion controls the part of the colon described as the fecal reservoir. 

C. The treatment in the neck. Hare says, "The vagus nerve when stim- 
ulated directly or reflexly increase peristalis." Always in constipation we 
stimulate the pneumogastric thereby increasing the peristalsis, in two ways, one 
by working along; the sterno-mastoid muscle and the other working upon the 
superior cervical ganglion which we reach at the sub-occipital fossa. 

D. Local: — Adjust the coccyx if displaced. Sometimes external man- 
ipulation is sufficient, sometimes, and usually, internal manipulation must be 
employed in the manner already described, but always in case of constipa- 
tion see that the coccyx is perfectly disposed that it may not act as a me- 
chanicalj'mpediment to the passage of fecal matter. A further local treat- 
ment is dilatation of the rectum, relaxing the sphincter muscle. This treat- 
ment is applied simply b)' insertion of the index finger and by a spreading 
motion. It should not be given oftener than once a week, once in ten days 
or two weeks. This rectal dilatation is a great stimulation to the sympa- 
thetic s}'stem and not only for normal bowel action, but it is frequently re- 
sorted to stimulate the lungs. In case of a patient sinking under anesthesia, 
one of the quickest and simplest ways to restore the patient is b}^ rectal dila- 
tation. 

E. Adju\-ants: — Remember that I simply give these to you as aids to 
your Osteopathic work, they are not osteopathy. If they were more fre- 
quently employed, fewer would suffer from this complaint. The use of 
water is of great benefit. The drinking of cold or warm water fifteen or 
twenty minutes or half an hour before breakfast is often sufficient to cause 
a full evacuation. It should not be taken with the breakfast as it does no 
good then. The theory is explained that when the stomach is empty a por- 
tion of the water, at least, is not absorbed directly from the stomach as 
water ordinaril}- is, but passes on into the small intestines and is there ab- 
sorbed by the lacteals and carried into the portal circulation and greatly 
stimulates the flow of bile. Often a good drink of water upon retiring will 
accomplish the same purpose. We frequently use anemas of hot or cold 
water. It is said that a small anema of cold water is a great stimulation, 
though anemas are usually given of water; as hot as can be well borne. It 
shoule be given by a fountain syringe, the patient lying upon the back or 



TRKATMKNT FOR CONSTIPATION. 53 

upon the right side, having the syringe hung at a heighth of six feet to in- 
jure a sufficient fall. About a pint should be given and the patient should 
immediately void this. The operation is repeated, this time giving one 
quart, three pints or even more of water stimulate gently by working the 
abdomen, in order that the water may be taken up into the bowel. The 
patient should now retain this as long as possible in order that the fecal 
matter may be well softened. Many make a mistake in voiding the water 
before it has been held sufficient time to act as a solvanc of the fecal masses 
which may have been quite hard. When he has held it as long as possible, 
usually that will not be but a few minutes, he should void it, and ordinarily 
the result will be satisfactory, Sometimes your patient will 
not be able to pass the water, but if retained it does nothing but 
good, as it is acting continually as a solvent and will probably within a 
few hours, lead to a profuse action, but if it does not it is readily absorbed 
and carried out through the kidneys and bladder. Drinking of carbonated 
and sulphur waters usually develops some good conditions. Uusally in 
sulphur water there is magnesium which has an aperient action. Graham 
bread contains salts which stimulate the normal action of the bowels also 
the roughness of the reminants of the bran is of itself a good stimulation 
of the bowel walls. Cracked wheat, oatmeal, vegetables, whole wheat 
bread, etc., are all alike valuable foods. Now remember that one may take 
too great quantities of these foods and become constipated. 

Again fruits are a great help. I will mention first such as are con- 
stipating and should be avoided, such as strawberries, blackberries and rasp- 
berries. Raspberry juice is frequently given in case of diarrhoea, where 
you readily note its constipating effect. But such fruits as apples, grapes 
(no seeds), stewed prunes, figs, dates, and juicy fruits, especially before 
breakfast, or the first thing at breakfast, are laxative. These are all valu- 
able, apples perhaps the most so, though different people are affected dif- 
ferently. It would seem, however, that apples, prunes and dates are to be 
given the preference. 

Regular habits should be encouraged. Defecation is found to be 
largely a matter of habit, acquired generations back and passed on frctm 
generation to generation. A certain hour should be fixed for the stool and 
the patient at least go and try to produce evacuation, never howc\er strain- 
ing as that may produce hemorrhoids, but by thus fixing the habit and plac- 
ing the mind on the desired end, you control the cerebral centers. 

Aside from the regular habit of going to stool, certain exercises are 
beneficial; remember first however that violent muscular exercise is given as 
one of the causes of constipation, and have your patient carefull\- avoid fa- 
tigue in exercise. The following exercises are recommended: 

First the stooping motion, the patient bending the knees, keeping the 
back straight, stooping down and raising, bring a pressing motion or squeez- 
ing motion upon the liver. He may, in bending downward, bend forward 



54 DIARRHOEA AND DYSENTERY. 

until the shoulders touch the knees. The same effect is accomplished by 
the patient getting down on all fours and running about the room. This 
simply seems to be a natural way of massaging the liver. The patient may, 
when he awakens in the morning, while lying upon the back, tap and mas- 
sage the abdomen gently and thoroughly and thus stimulate the blood and 
nerve force of the bowel and gain the desired end. 

Horse back riding and ordinary enjoyable exercises are all very good. 



LECTURE X. 

DIARRHOEA AND DYSENTERY. 

The success of Osteopathic treatment in both Diarrhoea and Dysentery i.s 
marked. As a rule the copious evacuation of acute Diarrhoea is checked im- 
mediately upon the fiist treatment, though frequently cases need more than 
one treatment, and sometimes become obstinate and chronic, requiring months. 

Dysentery, although a more serious condition, being essentially an inflam- 
mation of the bowels, yields readily to our treatment. The treatment is -simi- 
lar in both cases. 

Both of these conditions will illustrate, in their treatment, two points in 
Osteopathic theory: First, the condition of th^ spine as a predisposition to dis- 
ease; second, the remarkable control gained over visceral life by manipulation 
of the controlling nerves. 

Diarrhoea is regarded by some writers as a symptom merely of intestinal 
derangement, by others as a distinct disease. The word means 'to run through 
and as Hare observes is loosely applied to all states of intestinal disturbance 
accompanied by liquid stools, 

Aetiology; — Hare notes four varieties of Diarrhoea: i. Catarrh of the in- 
testines, leading to profuse secretion and passage of mucouf. Irritatiou^set up 
by old fecal matter may be enough to set up inflammation resulting in a dis- 
charge so that you may have alternation of diarrhoea and constipation. 2. Tack 
of proper innervation of the blood vessels allows of an outpouring of liquid from 
them into the intestines. Right here 3^ou want to guard against an error fre- 
quently made by some who treat Diarrhoea as if it were caused solely by too 
rapid peristalsis. They make the same mistake as is made in considering con- 
stipation always to be a lack of peristalsis. It should be considered simply as 
one of the classes. 3. Improper condition of the glands leads to improper pre- 
paration of the digestive fluids, and, 4. Ulceration causes irritation and bloody 
purging. 

Byron Robinson notes the fact that Diarrhoea may start as congestion, 
leading to oedema, rapid exudation, and Diarrhoea. Thus, catching cold fre- 
quently effects the bowels in this wa}^ particularly in young children. He fur- 
ther points out that. increased peristalsis mav be accompanied by too profuse 



DIARRHOEA AND DYSENTERY, 55 

secretion and exudation, but that on the other hand, increased peristalsis may- 
be accompanied by narrowing of the calibre of the blood vessels and lessened 
secretion. Thus the irritation that causes the increased vermicular motion 
may cause constipation instead of diarrhoea. Such causes as influence intesti- 
nal peristaisis are important to the Osteopath as he finds in spinal abnormali- 
ties the frequent cause of nervous irritation leading to Diarrhoea or to consti- 
pation. 

The processes of vSecretion and absorption normally balancing each other, 
may, says Robinson, become disarranged through the irritation of the bowel 
segments, e. g., by cathartic medicines. Owing to the increased peristalsis, 
not enough time is allowed for absorption of the secretions, and they are hur- 
ried through the bowel in the form of liquid stools. 

Displacement of spinal parts, etc., may be the cau.se of such irritation, as 
our practice frequentiy shows. 

The same author shows that catarrh of the intestinal mucous membrane 
may so affect intestinal secretions in quantity and character as to alternately 
cause Diarrhoea and Constipation. 

Dr. Harry Still says that in cases w^here he finds the liver extremely tender 
usually finds diarrhoea and constipation alternating. 

Causes of Diarrhoea are predisposing and exciUng. 

Predisposing causes are heredity; personal idiosyncracy; time of life, e. g., 
teething and the climacteric; and, from the O-^teopathic point of view, spinal 
conditions, any obstruction or irritation of blood or nerve life of the intes- 
tines. 

Exciting Causes are: — (Quain.) 

1. Direct irritation, as by poorly digested food upon the intestinal walls; 
entozoa; excessive bile, or retained fecal matter. 

2. Bad hygiene, as living in damp, badly lighted and poorly ventilated 
quarters. 

3. Exposure, wet feet, sudden atmospheric change, etc. 

4. Nervous causes, e. g. depression, worry, shock, grief, reflex irritation 
in dentition. 

5. Altered peristalsis and secretions. 

6. General diseases; e. g, of the heart, liver, lungs, pyaemia, peritonitis^ 
obstruction of the portal vein, measles, scarlitina, typhoid, etc. (Symptomatic 
Diarrhoea.) 

Osteopathic Theory. — While admitting the potency of varied agencies to 
cause Diarrhoea, the Osteopath believes that most cases can be accounted for, 
either remotely or directly, by some abnormal condition of some part of the 
spine, particularly of the splanchnic area and of the lower region of the spine. 
A spinal lesion of any nature, may le of such a character as to influence the 
nervous mechanism controlling the whole of the intestinal life and the result 
may be violent and rapid peristalsis; vaso dilatation of the messenteric vessels, 
followed by increaj^ed exudations, abnormal glandular activity, producing per- 



56 DIARRHOEA AND DYSENTERY. 

verted or needless secretions of intestinal juices; or inflammation and catarrhal 
affection of the mucous membranes, as pointed out above. 

As a predisposing cause, bad spinal condition stands pre-eminent. If the 
exciting cause be error in diet, exposure, undue nervous excitement, unhy- 
gienic surroundings, or a general disease, it may still be true that the bad spinal 
condition allows of a weakness of such a nature as to be readily 'developed into 
Diarrhoea by any one of these causes acting in conjunction therewith. 

Granted that in certain cases, e. g., when Diarrhoea is purely symptomatic, 
no such remote causes can be found in the spine, primarily, yet because treat- 
ment at the proper spinal position will overcome the symptom, the theory still 
holds good so far as to direct the operator to the origin of nerves governing che 
part affected, while contractured muscles, caused secondarily by irritation sent 
outward from the bowel through nerve connections to them, frequently indi- 
cate to us the proper point of treatment upon the spine. 

Dysentery^ (^Bloody Flux.) — This is a febrile disease characterized by intes- 
tinal inflammation, the passage of blood, mucous, etc., and great prostration. 
It occurs epidemically or sporadically, and attacks males and females of all 
agc^. 

Aetiology: — The causes of Dysentery seem to operate most freel}^ in tropi- 
cal climates, in damp or swampy localities. It is said to generally occur in re- 
gions which are prone to malarial infection, and that malaria seems to predis- 
pose to it by abdominal congestion, engorgement of ^he liver and spleen, and 
digestive derangement. Hence it is to some extent a constitutional dis- 
ease. It is seen in greatest virulence in army camps and hospitals, where it 
best manifests its epidemic character. 

Sporadic case^ are usually caused by some indescretion in diet, by .sudden 
chilling of the body, wet feet, etc. Impure drinking water, bad air, undiges- 
ted particles of food, and sudden changes in temperature which cause internal 
congestions, are all assigned as causes. 

It is stated that Virchow considers the epidemic form to be of a diphtheri- 
tic nature and the sporadic form of a catarrhal nature. 

The epidemic form is held by some to be contagious, but this is a mooted 
question. 

Pathology: — This is a disease of the large intestine, but may extend be- 
yond the ilio-caecal valve into the small intestine. The first change is a red- 
dening and swelling of the mucous m^embrane which peels off and is passed in 
the stools. 

Ulceration may attack and destroy the solitary glands, spreading thence 
to the tubular glands. From these ulcerations perforation of the bowel may 
occur. The ilio-caecal valve is sometimes destroyed when the dysentery is 
gangreous, and invagination follows. Ordinarilj^ the whole surface of the mu- 
cous membrane becomes colored with a dirt}^ varicolored slime, mixed with 
epithelial, blood and pus cells, and causing very offensive stools. Sometimes 
the mucous membrane decays, is sloughed" off and passed. 



DIARRHOEA AND DYSENTERY. 57 

Inflammation extends to the peritoneum and involves the mesenteric 
glands. It is said that the ulcerated tissue is probably never restored, and that 
occasionally serious contractions of the gut, or stricture, may follow the heal- 
ing of the ulcers. 

Symptoms'. — Are at first general constitutional and digestive disturbances, 
chilliness, malaise, fever in the evening, dry skin, constipation or relaxation of 
the bowels, anxious expression, occasionally retention of urine, and offensive 
stools are among the symptoms. 

The tongue is furred; there is a thirst and bad taste, evacuation is accom- 
panied with great pain followed by tenesmus, a bearing down feeling of the 
rectum; tormina or griping, is usually present. 

The stool is characteristic; described by Raue as being first liquid, with 
transparent, jelly-like clots of slime, like boiled sago. This matter is tinged 
with blood, contains little or no fecal matter, and later becomes thin, dirty 
white and watery. The sto .1 may become clear blood. The decaying mem- 
branes and ulcers give it a particularly offensive odor. Twenty, thirty or more 
stools are had in twenty -four hours. 

The attack is likely to prove fatal, and we must guard against such unfav- 
orable symptoms as hemorrhage, cold skin, great prostration, livid and blue 
countenance, collapsed abdominal walls, peritonitis, pneumonia, erysipelas, 
bed sore and hepatic ulcer. 

Osteopathic Theory: — Some spinal lesions, especially at the splanchnic area 
or at the third and fourth lumbar, disarranges blood and nerve supply to the 
intestines, thus acting as a predisposing cause, rendering the system more sus- 
ceptible to the infiuence of poor diet, climatic change or contagion. 

Treatment: Look for lesion along the splanchnics, and see that the 
coccyx is straight. There seems to be a special significance attach'^d to the 
nth and 12th dorsal. These seem to be centers particularly for peristalsis, or 
lesions of the nth and 12th ribs may influence these centers. The treatment 
for Diarrhoea is very simple. I place the patient upon the side and work along 
the lumbar region, springing the spine strongly. I do not hesitate to make it 
strong. Place the knees of the patient against you and give a very strong 
treatment. If the patient is a small man sometimes you can raise him off the 
table, and that will not be too strong a treatment. Of course you will have to 
gauge your treatment according to the condition of the patient. I work that 
way all along from the lower lumbar up as high as to the 6th dorsal. I hold 
for a minute or two then I turn the patient over onto the other side and repeat 
the operation. It is of course necessary to turn them over. Some operators 
think that by treating just on the right side they get good results. I think it 
is simply a matter of desensitizing the spine — inhibiting the nerves. Of course 
that sounds like the theory entirely of peristalsis, but you rule the vaso motor 
action there and you get effect upon the liver, spleen and soLir plexus. 

With the patient upon the back I raise the nth and 12th ribs, or with 
the patient upon his side I work in at the point of the nth and 12th ribs. Put- 



58 DIARRHOEA AND DYSENTERY. 

ting the thumb against the angle you can hold there strongly, with the idea of 
inhibiting nerve action. 

I never hesitate to have a good flow of bile to the intestines in case of 
Diarrhoea. The theory is that we work on the bile to stimulate its flow to the 
bowel, and 3^ou will find that it will act to allay irritation. I work on the 
course of the bile duct to insure a freedom of the flow of bile to the intes- 
tines. It will never do any harm in the case of diarrhoea or dysentery, as well 
as in case of constipation. This then is the general treatment in cases of diar- 
rhoea and dysentery and similar troubles. Now of course, if it is a severe case 
of dysentery, when you work upon the abdomen you must be careful not to 
run any risk of perforation, which is likely to occur. I work over the bowel 
-as in typhoid fever, simply to relax the tissues and free the flow of fluid, reach- 
ing the hypogastric plexus. In chronic cases where there is inflammation of 
the bowel, you wnll find the bowel contracted, and then by working gently but 
deeply over the site of the contracture you can relax. I am treating a case 
now of long standing. It seems to be chronic. There is a contraction of the 
bowel on one side cr on the other. It may be on the right or may be on the 
left, varying from time to time. I work on the centers along the spine. I 
spent considerable time one morning in giving the treatmeat in trying to relax 
this condition. I worked from the middle dorsal down, but none of it seemed 
to do as m.uch good as to get directly at the seat of the contracture by working 
jn the abdomen. You may say that tends more to massage than to Osteopa- 
thy. That is true so far as that case is concerned, but differs in having the 
origin of the trouble in the spine. 

We work first upon the spine, second upon the abdomen; we also work 
upon the 7ieck to stimulate the pneumogastric. Stimulation of the pneumo- 
gastric will increase the peristalsis, according to Hare. You bring pressure 
upon these nerves by working along the Mastoid muscle. You must make 
local examination and satisfy yourself that the coccyx is straight. Some- 
times it is displaced and is the cause of the trouble. 

In case of rectal troubles you must, of course, treat the sacral nerves 
as they have to do with the rectum. 

Also there are certain adjuvants which we may use. Quiet and rest in 
bed in severe cases, with proper care as to diet; meat broths, tepid (not hot) 
water, as hot water or hot liquid food will excite peristalsis. Use milk 
with lime water, also mucilaginous drinks such as white of ^g^ in water, 
milk, rice or barley water. Avoid fruits, except such as are constipating, 
e. g., blackberries and strawberries. Tea is an astringent. Strong tea and 
toast may be given. 

Ladies and gentlemen, this is not Osteopathy. It is simply common sense 
adjuvant methods that are used. One should not include these in Osteo- 
pathic treatment unless necessary. Ordinary cases of diarrhoea you will be 
able to stop with the treatment. 

As to Dysentery, the same general treatment given above will apply 



HISTORY OF MEDICINE. 

You must however give a more general spinal treatment, especially for the 
liver, spleen, stomach and intestine. Dr. McConnel has said that there is 
invariably a lesion at the 3d and 4th lumbar in case of dysentery. Get the 
liver active. Frequentl)- you can relieve portal congestion and do away 
with danger in that direction. 

In Tormina I sometimes bring deep pressure over the solar plexus but 
usually work upon the splanchnics. I have the patient upon the side upon 
a chair, and spring all along. This is the ordinary griping in the intestines. 

For the bearing down feeling in the rectum, strong stimulation in the 
sacral region will be sufficient. Sometimes it is necessary to give an enema, 
and then tepid water should be used. A mustard plaster may be good to 
relieve, but it should not be left on over twenty minutes, not long enough 
to blister. I have before mentioned that the patient should not be allowed 
to drink a quantity of liquid at once. Just a few spoonfuls of water should 
be given at a time to relieve thirst. 

Question. — In treating the Pneumogastric do you inhibit or stiinulate? 

Answer. — The general way is to hold strongly against the Mastoid 
muscle. We do not depend simply upon the pneumogastric in these 
troubles. I have not found that I could do so. 

Question. — How often do you give treatments for diarrhoea? 

Answer. — I treat such cases several times a day. It is owing to the 
nature of the case. If it is an acute case you must keep after it. Treat 
three or four or a half dozen times a day; will do no hurt. 

Question. — Would it do to give cracked ice instead of water to quench 
thirst? 

Answer. — Yes, that would do in small quantities. 



LECTURE XI. 

THE HISTORY OF MEDICINE. 

The Science of Medicine is defined as ''the theory of diseases and of rem- 
edies," (Encyc. Britt.) thus broadly including all systems and manners of re- 
garding and of treating disea.ses. It has existed, though not ahvavs as a 
science, since the dawn of civilization; schools of medical thought have risen, 
flourished and decayed, some leaving valuable contribuiions to the common 
fund of knowledge, while others have left but an empty name or the remem- 
brance of a grotesque theor3^ The mission of Medicine in the world has been, 
ostensibly, the alleviation of human suffering, and the prolongation of luuuan 
life, but of medicine, in the sense of the application of drug remedies, truly 
may it be said that it is more like David than like Saul, since it has slain its 
tens of thousands 

The progress of Medicine through the centuries has ever been upward; 
vast numbers of facts have been carefully recorded; quantities of books have 
been written; through diligent study and research the physician has become 



6o HISTORY OF MEDICINE. 

the most learned of men, and is fitly described by one of his own number as^ 
knowing almost everything except how to cure disease. 

The growth and evident success of a doctrine of Medicine within recent 
years, whose practitioners administer doses of drugs so highly attenuated that 
it is declared that by no analysis can any trace of the original drug be recog- 
nized, and one of whose practitioners, remarks the Encyc. Britt., claims to have- 
discovered decided results from olfaction, or the smelling of medicines, but- 
more especially by means of medicines contained in closed vessels held in the 
hand" leaves open to serious doubt the use of any drug remedy in disease. 
Many physicians believe of medicine what Prof. Magendie says of it, "Science 
indeed! It is nothing like Science," while the turning of the multitude for re- 
lief to such transparent frauds as Faith Cure and Christian Science, or to the 
more sensible methods, such as Massage, Rest Cure, Hydrotherap}^ and Physi- 
cal Culture, is indicative of the popular turning away from drug remedies. 

The old theory of disease was that disease was an entity, an idea originat- 
ing in the observation of technically described new growths, e. g cancers. Dis- 
ease, having produced such departures from the normal, and having resulted 
in that which was without its counterpart in the healthy body, was held to 
have acquired an '"automy," or peculiar independence, hence was an entity or 
a thing apart. 

Another class of diseases, not marked by such abnormalities, were known 
as physiological diseases, e. g. inflammations, rheumatism. Disease came to 
be regarded as a condition, which condition, or its essential nature is, in any 
given case, revealed to the physician of to day by a study of the cellular pathol- 
ogy of the case. Hence the theory of disease is based, through a knowledge 
of Pathology, upon Physiology, and "'a rational system of medicine," sa3^s- 
Bruntou, depends first of all upon a knowledge of the nature of the disease, 
or pathology. It depends, secondly, upon a knowledge of the action of the 
remedies that are to be employed in the disease, or pharmacology; and the 
knowledge of these two subjects depends upon a knowledge of the healthy 
structure of the body, or ''Physiology." This definition the Osteo- 
path may accept, having substituted for the word "pharmacology," the word 
"therapeutics. 

Whereas the physician halts often in contemplation of the cellular pathol- 
ogv, assigning for such condition various causes, external or internal; the Os- 
teopath, regarding cellular pathology as secondary, attends to the mechanical 
regulation of all parts of of the body related to the affected part. He often 
finds the sole cause in disarrangement of the mechanism, or he may find causes 
external or internal, as does the physician. In the latter case there may yet 
be mechanical causes responsible for a weakening of the tissues and the invas- 
ion by the disease. If no derangement of structure is found, as is sometimes 
the case, the Osteopath devotes his eSorts to controlling the condition of the 
system b}^ manipulation of nerve supplies, e. g. in a germ disease. 

Brunton divides drugs into two kinds, (i) Protoplasmic poisons, which de- 



History of medicine. 6r 

stro3^ all kinds of protoplasm, (2) Drugs which seem to have more or less affin- 
ity for variously differentiated protoplasms. Thus drugs act always upon the 
protoplasm, which is the physical basis of life. The Osteopath secures the in- 
tegrity of this protoplasm by controlling the quality or the flow of blood. 

The History of Medicine begins with early Greek civilization, though it 
is pointed out that savages and animals instinctively resort to such remedies 
as rest, herbs, abstinence from food, etc. For a long period of time preceding 
the Greek period, Medicine existed, not as a science, but as a crude mass of: 
knowledge, much obscured by myth and fable. To what extent the false en- 
cumbered the true, and superstition throve upon ignorance, may be imagined 
when one remembers to what degree superstition still rules the popular mind, 
especially in matters of healing, e. g., charming away of warts, etc. 

In connection with Joseph in Eygpt, about 1700 B, C, the Scriptures 
mention physicians and embalmers, thus implying some knowledge of anatomy 
and of the healing art. The position of the physicians then was less honorable 
than now, as indicated by the fact that the superstitious Egyptians would somQ^ 
times stone the embalmers after their work was done. 

The study of Anatomy probably began with the embalmers, who removed 
the brain through the nasal fossae, and the intestines through an opening in 
the left side of the abdomen. Pliny states that the Egyptian Ptolemies allowed 
investigation of the bodies of the dead for the causes of disease, thus notino- 
the origin of pathological study. 

Other ancient peoples had a knowledge of hygiene and medicines. The He- 
brews under Moses enjoyed some of the best directions concerning care of 
health. In the Pentateuch, ascribed to Moses as author, rules of health, such 
as avoidance of the flesh of the hog, circumcision, purification, relation of man 
and wife, public hygiene, and prevention of the spread of leprosy, are pointed 
out by Park. 

Among the ancient Indian races we again note the fact that the healino- 
art was in the hands of the priests, since the Brahmins alone were allowed to 
practice medicine. Their views are well illustrated in the following quotation: 
"They held the human body to consist of 100,000 parts, of which 17,000 were 
vessels, each one of which w^as composed of seven tubes, giving passage to the 
ten species of gasses, which by their conflicts engendered a number of diseases. 
They placed the origin of the pulse in a reservoir located behind the umbilicus. 
This was four fingers long by two wide and divided into 12000 canals, dis- 
tributed to all parts of the body." Astrology, demonology, the flight of birds 
and a casual observation of the patient's condition aided in the prognosis. 
Some idle circumstance was of greater importance than the symptoms of the 
disease. 

The unchangeable Chinese date their system of medicine at 26S7 B. C. 
and ascribe it to one of their emperors. This work is still their authoritative 
text. They examine the pnlse, noting three kinds, supreme (celestial) middle, 
and inferior (terrestial) and used lotions, plasters, baths etc., but had practi- 
cally no knowledge of surgery or anatomy. 



62 ^ HISTORY OF MEDICINE. 

The ancient Greeks were probably the wisest in medicine, and left to the 
^vorld valuable knowledge as a foundation of science. With them mythology 
had its place in medicine. Hermes or Opollo, was the author of medical works, 
and Aesculapius was worshipped as the God of Medicine. This man, it is 
stated, is quite separate from the early practice of medicine, he was not a prac- 
titioner but the deity of medicine, though one writer mentions him as being 
desired by Castor and Pollux to become the surgeon of the Argonautic Expe- 
dition. 

Among the Greeks the healiugart was at its highest state of perfection. Here 
again the priests succeeded in monopolizing the healing art, no one being al- 
lowed to practice unless he became a priest. It is a notable fact that among 
all peoples the art of healing has been closely associated in the popular mind 
with that of healing the soul. 

Bleeding still occasionally, though very rarely, practiced, is first ascribed 
to Podalirius, reputed to be the son of Aesculapius, who endowed him with the 
gift of "recognizing what was not visible to the eye, and tending what could 
not be healed." Thus is first indicated a classification of diseases into ex- 
ternal and internal which is always taken as meaning surgery and medicine. 
Among the Greeks first arose the habit of recording cases, they being first 
written upon the walls of the temples or upon tablets, V/here they were made 
the object of stud}^ by ntimbers of the profession. The following is mentioned 
by Park: "J^^i-"^ vomited blood and appeared lost beyond recovery. The or- 
acle ordered him to take the pine seeds from the altar, which they had three 
days mingled with honey; he did so and was cured. Having solemnly thanked 
the god, he went away." It is stated that purgatives, emetics, venesection, 
friction, sea -baths, and mineral v^aters were all used by the priests. All of 
which sound familiar to us today. Prayer was made, and deceit was freely 
practiced to influence the patient's mind; grotesque juggleries and extortion 
were common. 

Pythagoras was the founder of a school of philosophy. The Pythagorean 
physicians were the first to visit the homes of the sick, and were therefore 
called ambulant or periodic physicians. The Pythagorean Empedocles, 
a native of Agiegentum, first noted that a periodic pestilence which visited 
the city always followed the sirocco. He caused a wall to be built to direct 
the wind and thus free the city of the fever. Likewise he quickened the 
current of a stagnant stream in Selinus to which he attributed the origin of 
noxious vapors, and thus freed that city of a pestilence. 

In the Greek gymnasia physical culture, compulsory in those days, was 
taught as a means of preserving health. The physical directors who were 
physicians, treated the sick with drug remedies, dressed wounds, applied oint- 
ments, massaged, and reduced dislocations. Here may have been the origin of 
massage and a further development of surgery, but certainlj^ not the origin of 
Osteopathy, ^ince massage nor any of its methods is Osteopathy in any partic- 
ular. 



HISTORY OF MEDICINE. 63 

At a period when mythology was waning and history was dawning, ap- 
peared Hippocrates, known to us as ''The Father 'of Medicine," one of the 
brightest lights in the early history of medicine, who made observations and 
classifications of disease still in vogue. Hippocrates was of noble mind, free 
from the follies and superstitions of his day, with an exalted conception of the 
duties of the physician. He was of the faculty of famous school of Cos, and is 
stated to be the founder of the medical art as we now practice it. He possessed 
great skill in the use of instruments, which he imparted to his followers; he 
recognized disease as a condition regulated by natural laws, and with a tendency 
toward spontaneous recovery, which tendency alone could be successfully fol- 
lowed by medical treatment. To Hippocrates the present age is indebted for 
the m.ethod of close observation and accurate interpretation of symptoms. 

But little was known at that time of Anatomy, Physiology and Pathology; 
hence more dependence was placed upon mere observation of symptoms, thus 
originating the empiric method all too much in vogue at the present time. 

The Hippocratic school recognized four elements: earth, air, fire and 
water: and four conditions; heat, cold, dryness and moisture. Four humors of 
the body are described; blood, phlegm, yellow bile and black bile, (Humoral 
theory.) Right proportions and distribution of these meant health; wrong, 
disease, while the four elements must be in exact proportion in health. 

Another queer theory was that of Fluxions, a sort of congestion, produced 
by either heat or cold; the tissues by action of heat or cold, became more porous 
and the humor also became atteniiated. 

Hippocrates recognized the "Vis medicatrix naturae," and taught that 
the physician was to aid the sick man to overcome the disease. He recognize 
crisis in disease, and originated the habit of prognosis. In treatment, medi- 
cines were secondary, and exercise and diet of prime importance. "But," says 
Kncyc. Britt." "insensibly, the least valuable part of Hippocrates' work, the 
theory, was made permanent; the most valuable, the practical, neglected." 

Hippocrates was a voluminous writer, among his important works are his 
Aphorisms, 70 vols., important until recent times; on Fractures; on Articula- 
tions and Dislocations, Wounds of the head; Diseases of the Eye; on Fistula, 
on Haemorrhoids; Diseases of Women; Accouchmeut, etc., etc. 



LECTURE Xn 

HISTORY OF MEDICINE. 

The period in which Hippocrates lived is called the Philosophic period, 
50C-320 B. C. Following this came the Anatomic Period, 320 B. C. to 200 A- 
D., in which the most renowned names are those of Herophilus, Erasisiratus, 
Pliny, Galen. 

For one hundred years after Hippocrates but little advance is recorded in 
medical science, but under the reign of Ptolmey Soter, and his son, Ptolmev 



64 HISTORY OF MEDICINE. 

Philadelphus, great progress was made owing to their patronage and to their 
allowing of human dissections before interdicted. The Alexandrian Library, 
founded about this time, was another mighty aid to progress, felt uo less in 
Medicine than in other branches of learning. Herophilus and Erasistra- 
tus both enjoyed the privileges of the library and patronage of the Ptolmeys. 

The former, for whom the Torcular Herophili is named, is said to be the 
first to take up systmatic dissection of the human body. He was an admirer 
and follower of Hippocrates, having studied in the school at Coz. Among his 
writings are some upon the eye, pulse, midwifer}^, etc., and commentaries upon 
the works of Hippocrates concerning the membranes, vessels and ventricles of 
the brain, the tunics of the eye, the intestinal canal and parts of the circulatory 
system. He mentioned the thoracic duct. Thus it will be seen that under 
him the knowledge of anatomy was much advanced. 

Erasistratus was also a diligent anatomist but not a follower of Hippo- 
crates. He discovered the lymphatic vessels; declared the function of the epi- 
glottis to be to keep the liquids from, entering the lungs; described the valves 
of the heart more fully than had been done; wrote upon fevers, parlaysis, hy- 
giene, etc. He held that most diseases arose from decomposition of food in 
the stomach after overeating. He therefore bled and recommended fasting for 
this trouble which he called plethora. He depended on diet, baths, and exer- 
ercise much more than upon drugs, in his therapeutics. He elaborated a me- 
chanical theory of digestion (trituration) and of disease. 

These two names are important in connection with the Alexandrian School 
of Medicine. Each was the founder of a school. The Herophilists made great 
progress in Anatomy, but at last neglected it. The Erasistrateans gave much 
attention to special symptoms of disease and to drug remedies. They opened 
the way for the Empiric School, which disiegaided anatomy entirely, thinking 
it useless to seek for the cause of disease. They thus came to pay almost ex- 
clusive attention to the observation of the phenomona of disease, and thus set 
up pernicious habits of empiricism, treating of symptoms, which endure today. 

The Alexandrian schools as a whole did much to advance the knowledge 
of Anatomy, Surgery and Obstetrics. 

Empiricism rejecting anatomy, and necessarily knowing but little of Phy- 
siology, bcame firmly entrenched in the minds of Physicians, because in the 
midst of confusion of theories and ideas, it rested upon a foundation of exper- 
ience and observation which seemed to give it authority. It later fell into dis- 
repute through the ignorance of its adherents, and Empiricism became a term 
of anathema, until rescued later by the labors of Bacon, Locke and Condillac, 
under the name of the Experimental Method. 

Roman Medicine: — The earh^ Romans, it is said, possessed no distmct 
School of Medicine, and when about 200 B. C. the profession first appeared 
among them, it seemed to have come from the Greeks. One of the greatest 
names in Medicine belonged to a man of those times, Galen, whose name is 
closely connected with the development of Physiology. Galen was of the 



HISTORY OF MEDICINE. 65 

Dogmatic School founded by Hippocrates, he was very learned in all of the 
sciences of his time, and knowing all that was to be known of Anatomy, Phy- 
siology, and Medicine at that period, became a unifier of the various sects 
and theories, thus doing much to elevate the profession. He studied at Alex- 
andria, but, while a follower of Hippocrates, yet assumed an independent place 
as his successor. He recognized in man three principles, spirits, humors, and 
solids; of temperaments, resulting from the varying proportions of these three 
principles, he thought eight different kinds existed between the limits of health 
o,n one hand, and disease pn the other. Tlie human soul had three parts; the 
vegetative, found in the liver; the irascible, in the heart; the rational in the 
brain. He noted the difference between continued and intermittent 
fevers, and, together with Hippocrates, held that diseases were cured by con- 
traries. He wrote upon the skeleton, and, as none existed at the time in Rome, 
recommended students to go to Alexandria, where they could see and handle 
the bones. He described most of the bones of the body. The term "symphy- 
sis" is attributed to him. He classified the muscles as flexors and extensors 
and showed that thej^ were necessary to voluntary motion; located arteries and 
nerves between them. He was the first vivisector, since he exposed the mus- 
cles of living animals in his studies. Praxagoras had believed the arteries to 
contain air, whence their name, but Galen showed that they contained blood, 
and came very near being the discoverer of the circulation. Had he been a 
more independent observer, this prize would have been his. Park says here: 
**A little less reverence for authority, and a little more capacity for observa- 
tion, would have placed him in possession of the knowledge, lack of which for 
so many centuries retarded the whole profession." He did not understand the 
venous system, thinking all veins originated in the liver. Whereas Aristotle 
had taught that the nerves originated in the heart, Galen showed that the}' or- 
iginated in the brain and spinal cord, and he divided them into sensory, which 
he described as originating in the brain, and motor, originating in the spinal cord. 
He knew of glands, but supposed their secretions were excrementitious, and that 
they w^ere emptied into veins. He divided the body into cranial, abdomenal 
and aortic cavities. He supposed that air entered the cranial cavit}' 
through the cribiform plate of the ethmoid, passing out again by the same 
route, carrying excretions from the brain to be discharged through the nostrils, 
but part of the air became mingled, in the ventricles of the brain, with the vi- 
tal spirits of the body to form the animal spirits. 

It will thus be seen, that while Galen's mistakes were numerous, he did 
much for the advancement of Anatomy and Physiology. 

He strove to place the diagnosis of diseased conditions and their treatment, 
upon a physiological basis, the only true basis for practice, but his ideal has 
scarcely yet been realized in any school of medicine. 

In the period of Roman Medicine appears the name of Asclepiadcs, from 
•whose theory of atoms, conies the atomic theorj' of the constitution of matter, 
held at the present time. He held that the body was composed of minute ele- 



66 HISTORY OF MKDICINK. 

inents, eternal in existence, in constant motion, this motion resulting in the 
various phenomena of the body, The atom was imperceptible except to thought 
and was indivisible. It will thus be seen that his ideas in regard to the atomic 
constitution of matter are remarkably similar to those held by science today. 

His therapeutics w^ere based upon the idea of varying the sizes of the pores 
of the tissues, enlarging them to give exit to disease, or contracting them to 
keep it out. His favorite remedy was therefore exercise. 

A pupil of Asclepiades, Themison by name, was the celebrated founder of 
the school of methodists belonging to these early days. They held it to be vain 
to attempt to understand either the cause of disease, or the organ affected by 
it. Three conditions were found in all diseases: (i) Relaxation of the minute 
passages of the tissues, (2) Contraction of these passages, (3) a mixture of the 
first two, partial relaxation and partial contraction. Such a simple scheme of 
disease required but a simple system of therapeutics, namely to relax or to con- 
tract. There were no specific diseases, and they therefore dispensed with the 
specific remedies. A great man of that school, Soranus, is credited with hav- 
ing used the speculum at that early date. 

A Pneumatic school was formed in the first century A. D., whose doctrine 
was that the Pneuma, or universal soul, presided over pathological as well as 
normal activities of the body. It was seemingly an attempt to reconcile the 
theories of the Humoral (Hippocratic) school with those of the Solidist (Meth- 
odic) school. Its founder was Athanaeus. 

At this period, also, another school of medicine was founded, the name of 
w^hich is familiar today. The Eclectics were those of the school which strove 
to cull from each existing school the strong points and to combine them 
to form a new doctrine in medicine. 

Though the period of Medicine (400 A. D.) just described, was Roman 
Medicine, the Greeks performed most of the practice. In this period the science 
as a w^hole retrograded. Galen was not allowed to dissect human bodies, so he' 
dissected animals, especially the hog. 

Arabian Medicine: — Under the patronage of Haroun al Raschid at Bag- 
dad, progress for the science was made. He had medical books collected from 
all countries and translated into Arabic, he built schools and hospitals, and in- 
vited distinguished men to reside at his court. Supremacy in Medicine soon 
passed from Greek and Roman to Sarcen, and from the loth'to the 13th cen- 
tury is known as the most brilliant periods in Arabian Medicine. Yet but lit- 
tle progress in the science was made during the period, and the chief service 
rendered the cause of Medicine was to collect and keep alive the body of learn- 
ing already existing. A number of names are important in this period, but 
only a few can be noted in these lectures. Rhazes was the most noted of early 
Arabian physicians. He first accurately described smallpox and measles, and 
wrote voluminous medical works. Avicenna was the author of a great work in 
five volumes, w^hich added -nothing to existing knowledge. 

During these times the practice of Medicine was largely carried on by the 



HISTORY OF MEDICINE. 67 

clergy since it was in the monasteries that the books were kept and the know- 
ledge preserved by study. From the loth to the 13th centuries, the Jews were 
important practitioners of Medicine, although under the ban of the law, and 
were often called to attend prominent personages. 

Crude medical laws to restrict the practice, were enacted even at this early 
date. Theodoric, a Visigoth king decreed that a physician could bleed a wom- 
an of noble birth only with the aid of a relative or of a domestic; that if a pa- 
tient died from a surgical operation, the unfortunate doctor was given over to 
the friends of the dead man to be done vdth as they wished. Other laws were 
in keeping with these. 

A great school in the middle ages was the school of Salurum in the Wes- 
tern Roman Empire, at Salerno, Naples, founded b}^ Benedictine Monks. This 
school became a resort for sick and wounded crusaders, whose cases were sub- 
jects of study. Hippocrates and Galen were studied there, and important 
w^orks were produced, among which may be mentioned, "Antidotarium," a 
standard pharmacopoeia, whose system of weights and measures much resembl- 
ed ours of the present day, and the writings of Urso upon the pulse and the 
urine. 

In this school women firsi became prominent in Medicine. Tortula is sup- 
posed to have written "De Mulierum Passionibus." Other women were known 
at this time both as authors and as practitioners; they were much in demand 
because of their skill, and also became professors in the schools. 

■ The influence of this school was seen in the action of Emperor Frederick 
II, who united the variovs Medical schools of Salerno into a Medical Universi- 
ty, and enacted laws regulating the granting of licences to practice and the 
amounts of fees, etc. A physician must attend his patient twice each day and 
must go at night if called. Upon graduation of a student, he swore to observe 
the laws and to treat the poor gratis. "A book was then placed in his hands, 
a ring upon his finger, a laurel crown upon his head and he was dismissed with 
a kiss." 

Charms and relics were used in the school in treatment. Its practitioners 
understood such symptoms as nausea, vomiting, bleeding at the ears in injuries 
to the head, etc. They avoided patients suffering with trouble of the heart, 
lungs, liver, stomach, etc., as they feared losing them. They acquired con- 
siderable skill in surgery, performed lithotomy, and employed splints in com- 
pound fractures. 

Many of the Medical writings at this time were poems. Anatomy was but 
little regarded; but much depended upon practical experience and the observa- 
tion of clinic patients, thus the point is made that the Salernitan school bridges 
the gap between ancient and modern medicine. 



67 HISTORY OF MEDICINE. 

LECTURE XIII. 

Scholastic Period-. — Arabian Medicine began to gain an influence through 
translations of Arabian writings into Latin, and the Arabian teachings of 
Greek Medicine began to predominate throughout the profession. 

A new school was founded, now, at Montpelier [Spain] in which the 
Spanish Jews were most active. This school grew as the Saleruian school, 
mentioned in the last lecture, declined, and Arabian Medicine remained strong 
in influence until the Renaissance [i6th Century.] The authoritative sources 
of medical writings at this time were found in Arabian texts, and thus the 
medical writers at this period were called x\rabists. But the writings at this 
time are said to have been mostly commentaries upon Galen, Hippocrates and 
others, showing how they still influenced Medical thought and Medical litera- 
ature. 

It is interesting to note that this period produced the first English Medi- 
cal authors, Gilbert about 1290 wrote a "Compendium Medicinal," and Bernard 
Gordon, Scotchman and professor in Montpelier, wrote a Practica or Lilium 
Medicine. John Gaddecen, phj^sician to the king of England wrote Rosa An- 
gilica. All of these works are spoken of as visionary, speculative and super- 
stitious. Gilbert wrote of Leprosy, and Gaddesen may be particularly interest- 
ing to Osteopaths from the reason that he first emplo3^ed "laying on of hands" 
in the treatment of scrofula. 

Surgery, at this early date, was, as always, more progressive than Medi- 
cine. Among the prominent names of this profession" are those of Guy de 
Chauliac [1350] and John Ardern, an Englishman. Mondino [1275] was 
another great Anatomist; his works along with those of Galen, were read for 
200 years. Whereas dissections had before been done upon lower animals al- 
most entirely, he braved public opinion and the law in making public dissec- 
tions of the bodies of two women at Bologna. For a long time afterward no 
one dared emulate him in this matter. The objections of the clergy and the 
bulls of the Pope rendered human dissection impossible for many years. Guy 
de Chauliac was a most eminent and learned surgeon and author. He operated 
for dropsy, stone in the bladder, cataract, hernia, etc., was attacked by the 
plague and wrote a description of his sj^mptoms and the course of the disease 
that became classic. 

A curious custom of these times was the writing of scientific and medical 
works in poetry, and strange titles were used, e. g. "Flowers and Lilies of 
Medicine," the name of works dealing with the plague and veneral diseases. 

The healiug art, previously almost entirel}^ m the hands of the clergy, now 
began to be taken up by others, as shown by the oft repeated term 'lay-surgeon.' 
Priests thought surgical operations beneath them and often left them to travel- 
ing surgeon, while the barbers espoused the profession and were known as 
* 'barber-surgeons." 

During the Arabian Period of Medicine the Arabian people had emerged 



HISTORY OF MEDICINE. 68 

from the darknesss of ignorance and had become a polished people, only, how- 
ever to be over run by the Turks from the deserts of Tartary, a people of whom 
it has become proverbial that grass never grew where the foot of the Turk had 
trod. 

The Renaissance (i6th Century) affected Medicine as it did every other 
branch of learning, viz: It swept away much of the darkness of ignorance and 
superstition which had obscured truth and hindered progtess, and led to renewed 
study and investigation, resulting in enlightenment and advancement. 

The work done at that time was the origin of the present continuing 
scientific movement. The renewed study of the works of Galen stimulated pro- 
gress in Anatomy, while the discovery of the circulation of the blood, by Har- 
vey, gave new life to the much neglected study of Physiology. The w^orks of 
Hippocrates, Galen and Celsus, were studied and translated from the Greek, 
becoming thus the foundation of this new movement, their influence being still 
felt in Medicine today. A complete edition of the works of Hippocrates w^as 
translated into Latin. Mondinus, whom we have mentioned as dissecting the 
body of two women in Bologna, published a work upon Anatomy, illustrated 
with wood cuts. 

The embargo placed by the Pope upon the dissection of human bodies, 
was removed, dissections thereupon became general, much to the benefit of 
science. Jacques Dubois or Sylvius, grouped and named the muscles and de- 
termined their functions; he is credited with the discovery of valves in the large 
veins, and first used colored injections in studying blood vessels. He seemed 
to be unduly influenced by the authority of Galen. 

Vasalius (1514) was the great independent observer so much needed at this 
time. He dissected small animals and robbed cemeteries for human material. 
At the age of twenty-nine he became the author of the most complete anatomy 
yet written. He had the boldness to deny Galen's authority and to point out 
his mistakes. 

Columbus (1490) dissected many bodies, and nearly discovered the blood 
circulation, having noted the systole and diastole of the heart and their connec- 
tion with the dilatation and contraction of the arteries. He found that the 
pulmonary vein contained arterial blood and was acquainted with the pulmonary 
circulation. 

Kustachius and Fallopius (early i6th Century) were both great Anatomists 
and made discovery of parts^of the body bearing their names. 

The Arabian school of Medicine had added but few observations to the 
crude Pathology of Galen. 

Two men, Benivieni and Kustachius did much in this line. The former 
is said to have been ''the first who had the habit, felt the need, and set 
the useful example, which he transmitted to his successors, of searching in the 
cadaver for cause of disease." He made observations upon gall stones, the 
lesions of heart disease, and the transmission of syphilis from the mother to 
the foetus. 



69 HISTORY OF MEDICINE. 

At this time P'elix Plater (1536), a Swiss, classified diseases ''according ta 
the totality of apparent symptoms." Daring the period, also, of which we 
have been speaking, surgery fell behind Medicine and became of small repute. 
Owing to the social customs it had come into the hands of ignorant "barbers, 
bathers and bone-setters," simply because these classes w^ere proscribed from 
the trade of mechanic or artisan. 

The clergy, wdio practiced, were prohibited by the church from shedding 
blood. Hence surgery fell into the hands of the low^ classes mentioned, and as 
they saw no need for the study of Anatomy, it sank very lov/. This condition 
was changed about 1515, when the school gained authorit}^ over the surgeons 
and compelled a higher standard, i^.mbrose Pare (1510) w^as a noted surgeon 
w^ho first ligatured blood vessels in amputations, thereby avoiding the cautery. 

Paracelsus (1493) w^as the founder of the school of Chemical Medicine. He 
dispensed with the authorities, though he admired Hippocrates. He cut 
loose from all autIlorit3^ denied the utility of studying Anatomy, but since he 
regarded man as a microcosm vvhich he compared wdth the macrocosm, nature, 
a knowledge of the nature of man was to be gotten by studying external na- 
ture. He laid stress upon the curative power of nature, and gave Chemical 
Medicines, especially Antimon3\ Thus arose the school of Chemical Medicine, 
and the use of Antimony as a Medicine wss an important thing among 
its adherents. The value of his services to Medical Science is estimated to be 
small, or entirely nil. His school did not endure, though the practice of ad- 
ministering chemical medicines did. 

The result ot the Renaissance upon Medicine w^as primaril}^ to renew inter" 
est in ancient Medicine. Through new study of Hippocrates and Galen, and 
b}^ thus adhering to the old, taking Medical knowledge second hand, poorer 
results were obtained than w^ould have resulted from an entirely independent 
study. Yet the outbreaks of epidemics of hitherto unknown diseases compelled 
investigation along new" and independent lines. Another advance is noted in 
the introduction of the clinical method of instruction, one of the most practical 
and valuable now in vogue. This was first tried in Padua, Italj^ where the 
surgeon. Mcntanus, gave clinic instruction in St. Frances hospital. 

Leonard Botal, a French surgeon, was the first to employ bleeding to con- 
siderable extent. He bled weak old men from tvv'O to six times per annum, 
and thought it well to bleed a robust health}^ person once in six months. He 
had considerable success. 

During this period the profession of ph^-sicians was divorced from the 
priesthood; surger}" became m^ore closely affiliated with Medicine; schools in- 
creased in number, and hospitals and dispensaries w^ere founded. 

Some peculiar customs prevailed at this tim,e. For example, the students 
chose the ofiicers of the universities, sometimes the teachers, and took part in 
arranging the curriculum, a privilege which students of today would fain ex- 
ercise. Religious exercises were held before and after di^ssction, even though 
the cadavers were usually those of criminals, a custom, by the way, from 



HISTORY OF MEDICINR. 70 

which we of today have far departed. Demonstrations were given by surgeons 
but the dissecting, an unworthy job, was the work of barbers. 

Medicine in the \yth Century: — Just before the opening of the 17th Century 
it is said the world was in a woeful state. Devasted by wars and plagues, the 
peoples, superstitious and rude, were in poor condition for mental progress. 
Yet progress was made, be it said to the credit of the virility of the human 
mind. The improvement began with the Renaissance, and continued until the 
17th Century. The influence of Galen and Hippocrates in matters Medical still 
remained supreme, though the developing sciences of Mathematics and Physics 
led to a new independence of mind which lessened the quondam reverence for 
authority. This was a step in the right direction. Futhermore the formation 
of the cell-doctrine, the discovery of the circulation, the improvement of the 
microscope, together with other important discoveries furthered science and 
Medicine remark£bl3\ In this century arose several different schools and sev- 
eral prominent individuals who claim attention. 

Now the clinical method, begun in Italy, was introduced into Holland. It 
is to be noted that the clinical method of studying and making prominent the 
symptoms of disease, led to neglect of Galen and to exaltation of Hippocrates. 

Malpigi and Grew discovered that both plant and animal tissues were com- 
posed of cells, and advanced the important cell^doctrine, which is. at the bottom 
of the science of Anatomy, Physiology and Pathology today. 

VanHelmontisoneofthegreatnam.es of the 17th Century. He was 
really a successor of Paracelsus, founding a grotesque theory which recognized 
the fall of man as the origin of disease, and regarded demons, witches and 
ghosts as a cause of disease. He used mild remedies, andintroducsd some new 
chemical methods into' pharmacy. 

The discovery of the circulation of the blood ho-d important and immediate ef- 
fects, since it led to a reconstruction of the doctrines of Medicine upon a Phy- 
siological basis, and led to the founding of the Tatro-Physical of Medical, and 
the Tatro-Chemical schools. Many observers before Harvej^ had discovered 
facts concerning the circulation. They knew that blood was contained in the 
veins, but finding the arteries empty after death, supposed them to be filled 
with spirit. The liver was supposed to be tlie origin of the veins, the blood 
leaving it and returning to it, always through veins, propelled by undulations. 
This view was probably held by Erasistratus. Galen found that the arteries 
contained blood, that the great veins emptied into the right cavities of the 
heart, but supposed that it passed to the left heart through perforations in the 
septum. Michael Servetus, Columbus and Cesalpinus were more or less fully 
cognizant of the lesser or pulmonary circulation; valves in the vicns had been 
discovered as well as the swelling below ligature. 

William Harvey was an Englishman, born in K^nt. luigiand in 157S. 

This advance iu truth shared the common fate and was subjected to the 
bitter opposition of the omnipresent bigot. The new discovery was supported 
by the phibsopher Descartes. Harvey found no lack of new facts and argu- 



71 THE HISTORY OF MEDICINK- 

ments to adduce in favor of his theory, and saw it come into general acceptance. 

The capillary system, without which the theory of Harvey is incomplete, 
was discovered by Malpigi in the lung and mesentery of the frog. Leuwen- 
hoeck, with his improved microscope, saw the current of blood in the small ves- 
sels in 1690. It is said that Marchetti first demonstrated the capillary connec- 
tion of arteries and veins. 

The theory had beed held that the heart was an air chamber, that the air 
conveyed by the trachea, reached the heart by anastomoses of the bronchi wnth 
the pulmonary veins, Harvey's discovery disproved that theory. It was 
shown that the pulmonary veins did not conve}' air, but blood alone; studies 
were made of the respiratory motions of the chest; the difference between ven- 
ous and arterial blood was demonstrated by Goodwin, who experimented 
the frog, and noted the change in blood when passed through the lungs. It is 
said that an observer, Hassenfratz, filled a silk bladder full of venous blood, 
and then placing it in an atmosphere of ox3^gen, noted the change. These ex- 
periments and observations opened the w^ay for studies and demonstrations of 
respiration, how accomplished and for what purpose. 



LECTURE XIV. 

In addition to Harvey's discovery of the circulation of the blood, the dis- 
covery of the lymphatic system and its phj^siological action was of prime im- 
portance. Herophilus and Erasistratus had noted the lymph vessels, but had 
confounded them wdth arteries. Eustachius in 1563 discovered the thoracic 
duct in the horse. In 1622 Aselli, an Anatomist, accidentally dicovered the 
lacteals in a dog killed during digestion by picking a vessel and seeing the 
white fluid issue therefrom. Finally, Pecquet, a student at Montpelier, dis- 
covered the receptaculum chyli (1647) ^^^^ traced the thoracic duct to its ter- 
mination in left subclavian vein. These discoveries led to widespread interest 
in the subject, and to a working out of the blood making .system by the various 
Anatomists of the time. 

The seat of vision had been located in the crystalline lens, but Kepler 
demonstrated its true function, and he and Scheiner found that the optic nerve, 
terminating in the retina, was the true organ of sight. 

The general science of Physiology was much furthered by the discovery by 
Glisson of the irritability of tissue, a theory worked out later by Goerter and 
Haller. 

Two 17th Century schools of Medicine receive special mention. 

The Tatro-Physical school was an outgrowth of the study of Physiology. 
A Neapolitan, Borelli, was its reputed founder, and the principle of the schoof 
was to regard the functions of the body as resting upon a purely mechanical or 
physical basis. Bones were levers; digestion was trituration; nutrition and se- 
cretion depend upon mechanical tension of the vessel walls, while the heat o 



HISTORY OF MEDICINE. 72: 

the body was due to the friction of the blood-corpuscles against the vessel walls, 

Santoro, a chief man of this school, constructed a thermometer, and also 
measured the insensible transpiration of the body with considerable accuracy. 

The Tatro-Chemical School, founded by a Frenchman, Le Boe, was more 
nearly related to the practice of Medicine. But little application of the theories 
of the Tatro-Physical, or Physiological school, had been made to the treating 
of disease, and it is regarded as unfortunate that the tendency thus originated 
was of so little real value. Physiological practice has ever been the desirable 
thing in Medicine, but is almost as noticeably absent from the practice of the 
schools of Medicine of today, as it was from these of the 17th Century. 

The Tatro-Chemical school attempted to reform Medicine upon a basis of 
the use of chemical Medines and the newly discovered theor}^ of circulation of 
the blood. P'ermentation, taking place in the stomach, was an important phy- 
siological process. Too great acidity or alkalinity, would disturb the process 
and result in corresponding disturbances. Willis, the great English Anato- 
mist, was an adherent to this doctrine. He o^ave the earliest account of dia- 
betes, and wrote upon nervous diseases. 

Sydenham is an important name in Medicine in the 17th Century. He 
seemed to have been unprejudiced by any of the prevailing theories, and 
simply studied the disease as he found it, he was thus a follower of Hippocrates 
an empitic practitioner, though not to a fatal degree. He recognized the heal- 
ing power of nature, and held that disease was simply the result of nature's at 
tempt to throw off the unnatural condition. He attributed much importance to 
the history of disease and to the influence of the weather. Sydenham was 
really a great medical reformer, and exerted much influence in leading men 
back from theories to actual conditions. 

The 17th Century medicine, true to the spirit of the Renaissance, had been 
progressive, It had, however, simply opened tiie way for greater change and 
advances which were to follow in the i8th and 19th Centuries. The tendency 
of the 1 8th Century seems to have been toward the perfecting of the theoretical 
systems. 

To this period belongs the names of Boerhaave, a famous professor of 
Medicine at lycyden. He lectured at Leyden, and made the hospital there the 
center of medical influence in Europe. He followed the modern method of 
clinical instruction, and adliered to the views of Hippocrates and S5-denham. 
Hoffman attempted in his system, a synthesis of the views of "spiritual" and 
"material" schools. Stahl attempted to combat materialistic views of disease. 
His theory known as ''Auimism" made the soul the chief factor in the pro- 
cess of life. 

Haller and Morganni represent a reaction from the theoretical speculations 
of the teachers just mentioned and the latter with Sydenham founded methods 
upon which modern medicine rests. The former did work in Physiology of 
much influence in medicine. By defining irritability as a property of muscular 
tissue, and distinguishing between it and the sensibility of the nerves, he did 



73 



HISTORY OFMKDICINE. 



much to discourage speculations concerning the influence of the ''Anima" upon 
the body in health and disease. It is said that Physiolog}^, in the modern 
sense, dates from Haller, while from Morgagui dates modern pathological 
anatomy. His ante and post mortem, examinations were the basis of an im- 
portant work, which is said to have created a new epoch in science. The study 
of morbid Anatomy became, through him an important adjunct to medical 
science. 

The influence of the Brunonian system of John Brown, though shortlived, 
seemed to have been considerable at the time. He believed that the processes 
of life, disease and cure of disease rested upon excitability. External forces 
and functions of the system w^ere exciting powers which called forth the mani- 
festations of life. He classes diseases as sthenic and asthenic, and treated them 
respectively wdth agents of depletion and of stimulation. 

At this time arose Homeopathy, the system of Hahnemann. His motto 
was ''Similia Similibus cii7'a7ituin '' [Galen's.] Hahnemann declared disease to 
be the totalit}^ of symptoms, and therefore regarded as useless investigation of 
the cause of disease. He rejected the teachings of pathology and miOrbid anat- 
omy, as well as the Vis medicatrix 7iaticrae." He says "For as far the greatest 
number of diseases are of dynamic [spiritual] origin and dynamic nature, theii 
cause is therefore not perceptible to the senses." He held that nature was a 
bad healer, and drugs were the agents of God to cure diseases. Medicines ad- 
ministered to healthy persons caused symptoms of diseases they could cure. 
Hence the doctrine ''Simiiia Similibus Citratur,'' a motto which however, is 
not original with Hahnemann, since Hippocrates, Paracelsus, and oth(;rs used 
the phrase before him. A distinctive feature of this system, one seemingly or- 
iginal with Hahnemann, was the attenuation of medicines, styled "dynamizing" 
or "potentizing" of the medicine. He held that dilution developed the spirit- 
ual power that lay hidden in the Medicine. He held that all diseases of a 
chronic character are caused by either itch, sj^philis or sycosis [skin disease.] 

Homeopaths, after a hard fight, have come to be generally recognized in 
this country, having been recently, during the Hispauo- American war, recogniz- 
ed by the U. S. government in the army service. Homeopathy, it is said, must 
be credited with drawing attention strongly to therapeutics, while it seems to 
a "man up a tree" that in general its success in the treatment of diseavSe is as 
great as that of its enem}^ Allopathy. Possibly the case recovering with its rem- 
edies ''would have gotten well anyhow," as physicians say of cases cured by 
Osteopathy, and there still lurks the suspicion that the curative power of drugs 
attenuated beyond the reach of chemical analysis must be about equal to the 
healing virtues of the colored water and chalk powders of the Allopath, and 
that, after all, the real explanation of the recovery would be found in the re- 
cuperative power of nature, untampered with, and in the aid afforded by good 
nursing. Witness the statement made by Magendie, former head physician in 
Hotel Dieu, Paris, who saj^s that he divided the 3000 or 4000 patients passing 



HISTORY OF MKDICINR. 74 

every year through his hands into three classes, giving to one the usual reme- 
dies, and to the other bread pills and colored water, occasionally creating a 
third class to whom he gave nothing whatever. The greater mortality was 
among those of the first class, many of the second class recovered but more of 
the third were restored to health. Men like Sir Ashley Cooper and Oliver 
Wendell Holmes, shake ones faith in medicines by declaring against them. 

Keith, an P'nglish Physician, in his "Plea for a Simpler Life'' discards 
medicines almost entirely, and talks of success in cases of scarlet fever, apop- 
lexy, haematuria; haemorrhage of the stomach, etc., without their use. 
We all know that similar statements made by the most eminent authorities, 
might be multiplied to a great number, that doctors give less medicine as they 
grow older; that prescriptions contain fewer drugs now than formerly, while 
the "drug habit" stands in ill repute. 

To return to the history of medicine. The i8th century produced in Italy, 
Antonia Maria Valsalva, eminent as an observer, practitioner, and lyancisi, 
anatomist, and author of a work upon diseases of the heart and aneurism. In 
France of this period, Senac was the author of a book upon heart disease, and 
Sauvages wrote Nosolgica Methodica, a natural history classification of disease. 

Among English physicians, Fothergill studied Diphtheria and Tic Doul- 
oureux; Jenner introduced vaccination as a preventative measure against small- 
pox. In Germany, in this century, a Vienna physician, Leopold Arenbrugger 
invented the system of percussion of the chest in diseases of that region. He 
practiced immediate, not mediate percussion, using the tips of the fingers. His 
book written upon the subject, was called Seventeen Novum. His discovery, 
like many good things before and since, w^as first ridiculed and later adopted 
by the medical profession. It is said that this discover}^ simple as it was, did 
more for the real advancement of medicine than the building of the many sys- 
tems of medicine witnessed by the centur3\ 

In the early part of the 19th century arose the modern school of medicine. 
It is characterized b}" methods of research, giving less weight to theorizing and 
abstract speculation than previousl5^ The growth of modern medicine was 
most marked in France and England, later in Germany. 

In France, what is knowm as the positive school of medicine, grew up. 
Bichat, an Anatomist and Physiologist, wrote an important work, General 
Anatomy. 

Broussais, a prominent follower of Bichat, sought to explain all diseases 
upon an Anatomical basis, e. g. assigning all fevers to intestinal irritation or 
inflammation. He called his method Physiological medicine, and emphasized 
the study of pathological school of Corvisart, Laennec and Boyle. 

Laennec originated the method of auscultation in physical diagnosis, the 
basis of which was auscultation and percussion. It is said that the method of 
Laennec revolutionized the study and knowledge of disease of the chest, and 
was the more valuable in that it was coupled with very careful study of the 
pathology of the organs examined. 



75 HISTORY OF MEDICINE. 

Boyle worked upon tubercles, and studied changes in the lungs and other 
parts of the body in tuberculosis. I^ouis introduced the numerical and statisti- 
cal method of keeping a close record of cases, thus avoiding the error of judging 
merits of treatment by isolated cases. Osteopathy makes a serious mistake in 
neglecting statistics and records of its cases, laying itself liable to the charge of 
lack of scientific method and taking to itself credit for cases accountable for by 
coincidence, the law of chance, etc. 

In England during this period the important names embrace those of Eras- 
mus Darwin, grand father of Charles Darwin, the great scientist, and of the 
Hunters, William and his brother John. The former was a great anatomist 
and pathologist. Richard Bright described the disease of the kidneys named 
for him. 

Bell and Hall did important work upon the spinal cord and its disease. 
John Abercrombie published a work upon disease of the brain and spinal cord. 

In the German school, at this time, Karl Rokitansky did much to place 
morbid anatomy upon a permanent foundation. 

One marked feature of medicine of the present day is that, in spite of the 
progress made, there is a wide spread and increasing dissatisfaction with its re- 
sults, both in the profession and outside, and a constant tendency to turn to 
new methods. 



IVIASSAGK, SWEDISH MOVKMENT AND MAN'QAE TREATMENT. 76 

LECTURE XV. 

Massage, Swedish Movement and Ma?i2ial Treatment: — These are all forms 
of mechanical therapeutics. All are, at least in part, manual systems, 
the treatment being admini>tered with the hands. In each system not only 
manipulative proceedure is employed, but also gymnastics are used, i. e. passive, 
resisted, or free movements on the i;art of the patient. Massage seems to con- 
sist largely of manipulations made by the operator on the patient's body, while 
Swedish movement, though including these manipulations, make prominent 
the active gymnastics of the patient and is called also Medical Gymnastics. 

The s^^stem of manual treatment ascribed to Ling, a Swede, seems to be a 
more thorough form of massage in which the manipulations predominate, but 
including also certain active movements on the part of the patient. 

In general, these systems are but little understood, and are far more thor- 
ough as methods of healing than is generally supposed. In the hands of skill- 
ful operators, usually doctors of medicine, remarkable results have been accom- 
plished in the cure of disease. These systems are generally employed by mas- 
seurs without technical education, and thus have come to be generally misun- 
derstood; being as a rule unskilifully applied, and by unsceintific operators, 
the results have not been such as the systems are capable of producing. How- 
ever, none of these forms of treatment are Osteopathy; all differ from it radical- 
ly, yet since they arc systems of manipulative therapeutics, and since, unavoid- 
ably in any such general mode of treatment, there are certain resemblances in 
method, inmanner or in results, Osteopathy has been frequently confounded 
with these other methods. 

Massage is the general term used by the average man to designate all forms 
of manual treatment, hence Osteopathy has become to him massage. 

In Eccles' "Practice of Massage' five different forms of manipulation are 
described, as follows: 

1. Effleurage, or stroking; for effects upon the skin; given in a centripetal 
direction to aid the flow of lymph and blood toward the heart. 

2. Petrissage, or kneading; deeper than stroking; for effect upon skin and 
muscle in direction of blood flow to the heart, and for the purpose of squeezing 
out the waste from the tissues. It stimulates lymph and blood flow. 

3. Tapotement, or tapping, clapping or hacking. This is given with the 
dorsal surface of the second and third phalanges, with the ulnar or radial bor- 
der of the hand, for the purpose of affecting deeper structures, i. e., for stimu- 
lation. 

4. Vibration, a quick vibratory motion, variously administered, given 
over chest, abdomen, nerve trunks, etc., for stimulation of the deeper viscera 
or nerves 

5. Massage, a friction, a sort of circular friction, generally employed about 
joints to soften tissues and muscles; said to be very useful in sprains, strains 
and rheumatism. 



77 MASSAGE, SWEDISH M0VE3IHNT AND MANUAL TREATilENT. 

These five forms of motion, sometimes more, are described by the different 
authors. There is much variation in the technique. Usually a masseur, after 
a course of study, will throw aside his boois and adopt a system of motions of 
his own. Yet, unlike in Osteopathy, the manual of technique, or the exact 
mode of administering the various movements, is made very important by the 
authors. One example will illustrate the detail with which these motions are 
described, and the careful attention that is bei^towed upon the manner of giving 
the treatment; 

"The rubber, remaining upon the left side of the couch, uncovers the left 
lower limb, and with the right hand delivers a series of rapid frictions from the 
toes upward over the dorsum of the foot, external surface of the ]eg, the knee, 
and front and external surface of the thigh; then with the left hand, the knee 
being semi-flexed and the thigh slightly abducted and rotated outward, the 
sole of the foot, calf, inner side of the knee and thigh, are also lightly and 
briskly rubbed; then, recovering the limb; and exposing the foot and ankle 
onl}^ the more detailed treatment of the foot is given. Supporting the sole of 
the foot in the palm of he left hand, the heel resting in the semi-flexed fingers, 
friction over the dorsum of the foot and the front and miter surface of the an- 
kle is performed in much the same manner as that of the back of the hand," 

The masseur thus goes over the body in detail in general treatments. 
There is special massage for the limbs, the heart, the lungs, the eyes, the face, 
the ear, the head, the bladder, intestines, etc. 

The time required for treatment varies from a few moments to three quar- 
ters of an hour or an hour and a quarter. 

In addition to the movements described, massage includes voluntary mo- 
tions by the patient, sometimes aided, sometimes free, sometimes resisted by 
the operator. These come after the passive massaging, and are for the effects 
of exercise or to develop any special part. 

Swedish Movemeiit is, according to Dr. J, H. Kellogg, a "system of medical 
gymnastics," a "physiological mode of treatment of diNcase," As indicated by 
this definition, the system consists largely of active gymnastic exercise upon 
the part of the patient. Massage, Dr. Kellogg terms a special feature of the 
Svvedish movement. He states the principle of Swedish movements, "that mus- 
cular movements are a powerful means of affecting physiological processes and 
that when gymnastics are used therapeutically, they must be employed with 
the same accuracy and precision with which the physician regulates the doses 
of medicinal agents." Thus we see that the idea of gymnastics is made prom- 
inent. Incidentally, the movement already described as massage, and other 
passive movements are used. Such are hacking, clapping, beating, stroking, 
kneading, fulling, sawing, etc. A great variet}^ of movements are indicated 
and fully described, certain physiological effects being expected from a given 
definite movement. Compound words are used, and the terms read something 
as follows: "(i) Sitting, chest-lifting; (2) half-lying, foot-rolling; (3) high- 
ride sitting, trunk-rolling; (4) fan sitting, arm-rolling," etc. 



MASSAGE, SWEDISH MOVEMENT AND MANUAL MASSAGE. 78 

The above is taken from a receipt of movemeDts given for congestioil of 
the brain. 

Peter Henrik Ling, the Swede, is credited with being the originator of a 
system of Swedish movements. A work called Ling's "System of Manual 
Treatment" gives more prominence to the manipulations of the operator, but 
describes also activ*e movements to be made by the patient. 

The idea prevalent among us that massage does not require a knowledge 
of anatomy is a mistake. 

These systems are founded upon a most thorough knowledge of Anatomy, 
Physiology and Physical Diagnosis. Yet it is probably true that massage and 
the like, as usually administered, are in the hands of persons who have but a 
superficial knowledge of these sciences. 

These forms of treatment are given in both acute and chronic conditions 
with important results. 

In Swedish movements, motions are indicated for laxative effect, for ab- 
dominal disease, haemorrhoids, frequent menstruation, etc. A long list of re- 
ceipts of combinations of motions is given for such conditions e. g. as Anemia 
and Chloroses; Scrofula, Diabetes Mellitus, Hysterics, Tremors, Colic, Bright's 
Disease, Pott's Disease, Prolapsus Uteri, Leucorrhoea, etc. 

The effects of manual treatment are interesting. Passive movements act 
upon venous and lymphatic circulation, and are made in the direction of these 
currents. 

Stroking stimulates the pilo motor nerves, leads to a contraction of the ar- 
rectores-pili muscles which causes the sebacious follicles to be pressed upon, 
thus aiding secretion. 

By rubbing, rolling and squeezing of the skin, the superficial circulation 
is stimulated, the capillaries dilated, and the pulse-rate slowed. 

Firm kneading of the muscle is followed by a slow pulse-beat, and in case 
a large muscular mass is kneaded, a fall of blood pressure in the body is noted. 
Kccles states that "it is possible that pain occuring in the deeper organs may 
be modified by manipulation over the superficial areas corresponding to the dis- 
tribution of the cutaneous sensory nerves derived from the same segment of 
the spinal cord as that from which the sensory nerves of the disturbed viscus 
are derived." Thus effects may be gotten upon the heart and lungs by exter- 
nal work He summarizes the effects of massage as follows: 

1. "Mechanically and directly, elimination of waste products from the tis- 
sues under manipulation is increased, the absorption of exudations and infiltra- 
tions is greatly favored, adhesions are attenuated, sometimes broken down, 
and even organized thickenings may be reduced. 

2. Nutrition of the part is improved, vascularization is increased, and me- 
tabolism is augmented. 

3. Indirectly, massage acts as a derivative, relieving congestion of the in- 
ternal organs by attracting the flow of blood to the surface, and muscular vi- 
brations are set up, stimulating the nervous system, acting through it renexly 



79 MASSAGE, SVv'EDISH MOVEMENT AND MANUAL MASSAGE- 

thus exciting secretion; while on the other hand, its sedative influence relieves 
pain and reduces over activity "' 

KellRTen claims for nerve vibrations: 

1. "Raising of the nervous energy. 

2. "Diininatiju of pain [assesii in facial neuralgia an i migraine.] 

3. "Contraction of the smaller blood-vessels [heaviness of the head is 
quickly relieved by stiniulation of the sensory nerves of the scalp.] 

4. "Stimulation of the muscles to contraction. 

5. "Increased secretions of the glands. 

6. "Diminished excretion from the skin. 

7. "Decrease of temperature [as in fevers.]" 

These are given as examples of results claimed for manual treatment. 
Much more might be added. 

Osteopathy is not Massage or Swedish Movements. While there are simi- 
larities, there are radical differences: 

1. These other forms depend largely upon the general gymnastic or man- 
ipulative effect upon the body. Osteopathy does not depend upon general ef- 
fects from general treatments, but upon specific treatment. 

2. They emphasize the method of the motion which, to the Osteopath, is se- 
condary. A good masseur must be an expert manipulator in the particular 
sense of having a knack to give certain movements. 

3. They are much more laborious and require a much longer time per 
treatment than does Osteopathy. Sometimes a single motion is sufficient Os- 
teopathic treatment, or effects a cure. 

4. Osteopathy requires no gymnastics of the patient as a part of the treat- 
ment. 

5. They go over the parts of the body in detail, which Osteopathy does 
not do except in examination. 

6. They make no search for any lesion or abnormality about the bodily 
mechanism, while Osteopathy finds in such lesions, e. g., a misplaced part, the 
most scientific cause of disease. 

7. They do not go to nerve centers and nerve distributions in the way that 
Osteopathy does. They work upon them in a general way and only because 
they are readily reached. They do not seek for and remove lesions therefrom. 
On the other hand, Osteopathy goes to the definite nerve centers to influence 
the health of the body, and often removes obstructions from such centers, al- 
lowing normal action. The same is true of blood flow. 

In these last two points is seen the most radical difference between the sys- 
tems. Upon the whole, these manual systems compare with Osteopathy as 
does the shot-gun with the rifle. They produce excellent results by the "shot- 
o-nn method" of general manipulation, while Osteopathy works with the defi- 
nite aim of finding the obstruction to health and removing it. It is unavoida- 
ble that, if such a comparatively "hit-and-miss" method as Massage can secure 
excellent results as a curative means, Osteopathy, with its definiteness, must 
generally far exceed massage in results. It also follows that the former must 
generally work more quickly and easily than the latter in such cases as the lat- 
ter could reach, and that it must succeed in a large class of cases beyond the 
power of these manual systems, since to this class belong so many disease condi- 
tions depending upon some removable obstruction not noticed by them. 



ii>riDEx:. 



^^^^ 



A'TI.AS 35 

location of 5 

cause of trouble 15, 99, 104 

case of paralysis 16 

disease of 26 

lateral displacement of 36 

to treat .93 

in ear trouble iir 

Arm, vaso-motors to. ... 6 

dislocation of 183 

Anus, sphincter 7 

Abdominai, Brain 7 

Aorta, location 10 

arch, position 119 

sound is heard 124 

bifurcation ..143 

AbscesF, to absorb ■.>. 52 

Anemia 82 

how produced. 60 

venous hum in jug. vein 68 

mucous membranes 100 

Ankylosis, prevented 74 

ligamentus 74 

Asthma, frequent treatment 89 

condition found in 121 

case rapid heart beat 132 

Antrum of Highmore, to tap 109 

Aneurism, of aorta 143-153 

Angina Pectoris, cause clavicle displaced 133 

Arteries, renal 10 

common carotid 75 

sub clavian 75 

temporal , 98 105 

supra-orbital 98 

occipital 98 

posterior auricular 98 

coronary . 105 

innominate 119 

axillary 122-I84 

internal mammary 122 

perforating location 122 

gluteal . . .164 

pndic 164 

spermatic 177 

ovarian 177 

femoral 186 



Abdomen, considerations of 138-140 

nerve centers, connections. ..140 

tumor, cause of 140 

landmarks 143-151 

to treat I49-I57 

region ^52 

contents of ^54 

examination ^55 

auscultation i57 

measurements of 158 

Abortion, stimulation of nipples 182 

Apoplexy, treatment of 200 

Auscultation, of chest 126 

of heart ^34 

B 

Bronchi 4 

irritation of ^45 

Bronchitis, caused by clavicle, i, 2, 3 ribs 135 

Breaks, 12th dorsal 5 

5th lumbar 5 

Bacterial fever, treatment for 203 

Bladder, center for neck 7 

motor fibres to ^42 

sphincter ^42 

peritoneum ^44 

position • 144- 154 

position in over distension 154 

sphincter, to relax and contract 175 

treatment 176 

to raise ^76 

Brain, cervical 7 

abdominal 7-26 

pelvic 7 

to affect S 

blood supply affected 16 

Back, to examine 27 

Bowels, peristalsis 8 

to move quickly 20 

Blood vessels, nerves to 9 



to affect. 



■39 



by removing lesions . . .51 

under nerve control 58 

Blood supply, affectiug nerve life 60 

Bright's disease, consideration of 19S 

treatment of 19S 

Barber's itch, treatment , 201 



85 



INDEX. 



c 

Cervical Nerves, upper, lesion of i8 19 

origin 3 

Correspondence of vertebra and scapula. . .4 
vertebra and ribs 4 

Centers, sympathetic 6 

description of 6 

important 9 

for superficial fasciae 9 

theory of work on 37-38 43 5o 53 

'* '' " 56-6370-78 

theory by Lawrence Hart 56 

anemia of 60 

hyperemia of 60 

face and head 107 

of abdomen 140 

peritoneal to kidney 148 

for lungs 6- 1 16 

cilliary 6 

for stomach 6 

for pyloric orifice 6 

for chills 6 

for liver 6 

for parturition 7 

for micturition 7 

for dif ecation 7 

for hypogastric plexus 7 

for neck of bladder 7 

to relaxvagina 7 

of sensation 7 

of motion, 7 

of nutrition 7 

for cough 7 

for sneeze 7 

for vomit "* 

for respiration 7 

for salivation 7 

for phonation 7 

for deglutition 7 

renal 7 

spasm ' 7 

vase motor • • • 7 

cillio spinal 7 

to dilate iris and contract pupil 7 

heart 7 

Complexion 99 

Coeliac, axis 7 

Cervical, brain 7 

Cough, center. 7 

treatment for 19^ 



Chest, barrel shape 121 

rachitic 121 ' 

divisions of 1 24 

movement of 125 

examination of 125 

flattening of 127 

role the shape 132 

Center, for cervix uteri .7 

blood supply to ovaries 7 

for bowel 166 

Colon transverse, position 144 

foccal reservoir 16S 

flexures displaced 156 

Center, v? so-motor to lungs 8 

vaso-motor to jejunum 8 

vaso-motor to small intestine 8 

vaso-motor to large intestine 8 

vasomotor to liver 8 

vaso-motor to kidneys 8 

vaso-motor to spleen 8 

vaso-motor to lower limbs 8 

vaso-motor to valves of heart 8 

yaso-motor to bowels ; 8 

vaso-motor to larynx 8 

Coccyx, cause of piles 11 

cause of trouble 15 

dislocation of 54 

to set .54 

cause of diarrhoea 167 

Constipation, cause 14 154 

treatment by mind case 98 

Curvature, cause of trouble 16 

to set 37.54 

post (Potts) 73 

Cervical, disease, Hilton 19-20 

Crutch paralysis - 19 

Cramp, writers.. 19 

pianists 19 

violinists 19 

Cold feet, 42-203 

Cold liver 121 

Chemicals, abnormal effiect 40 

Contractures, effect of 58 64 

how to recognize 65 

causes of 65 66 

relation to nutrition 66 

Chlorea,caseof ^ 67 

lesion found 67 

causes 67 

Cartilege, thyroid 68 

cricoid 68 

costal displaced 128 



INDKX. 



86 



Clavicle, to treat ,. 83 

to set 129 

caase of bronchitis 135 

examine 121 

Catarrh, tenderness at jaw angles 69 

to treat jaw 83 

treatment of 1 95 197 

Congestion, to relieve 118 

Coracoid process, fibers of deltoid below. 121 

Congestion, of lungs 135 

Cramp, in intestine, how to treat 166 

in feet 186 

Chill, treat lungs and heart 192 

Chills and fever, treat 192 

Cholera, treatment of 198 

Colic, treatment of 201 

Convulsion, cause of 201 

D 

Disease, 3 

of spine origin 16-21 

cervical 19 20 

Diagnosis, 3 

diagnosis by telephone 3 

correct 20 

osteopathic -24 

Dorsal nerves, origin of 3 

6 and 7th cause of trouble. 21-25 

DiseBse, Potts 73 

Groves io5 

Deglutition, center for 7 

Dr. Still, centers spoken of 7 

superficial fasciae 9 

engine wipers 93 

treatment of claricle 129 

on ligaments 172 

Diaphragm, central tendon of 10 

trouble, cause 24 

phrenic distribution on 96 

stoppage of aorta 132 

Diarrhoea 14 

cause 14-167 

to treat 87-166 

in infants 199 

case cured 167 

Dyspepsia, cause of. 50 

Dislocation, hip case 2o-5o 

hip, indications by toes 187 

hip, obturator. 188 

hip, dorsal 18S 

of vertebra to reduce 36 

arm 183 

elbow 184 

elbow, reduction of 1S4 



Dislocation, ankle 187 

knee 187 

Desensilization, 28 

osteopathic definition 32 

Drugs, abnormal effects 40 

Degeneration, Wallerian . . . . 8r 

Duct, Wharton 109 

Deafness, cause of no 

case cured 1 10 1 1 2 . . 

Diphtheria, treatment of 193-194 

lesion in I94 

Duodenum, location of 10 

E 

Erysipelas 3 

Ear 3 

to affect 8 

nerve supply 18 

ache, cause 19 

trouble caused by atlas 99 

to examine no 

external no 

middle m 

appearance if inflamed m 

to test Ill 

to treat ••• m 

how to remove m 

insects to remove m 

blood supply to treat m 

cause of trouble cured 112 

to treat 112 

Erector Spinae. 4 

Eye, to affect S 

an indicator of disease 100 

to examine 100-105 

osteopathic points loi 

blood shot, to treat loi 

vaso motors 102 

to treat 102-106 

brilliance 105 

dull I05 

lids granulated 106 

lids granulated 106 

landmarks concerning loS 

puncta lacrymalia loS 

Esophagus, perforates diaphragm 10 

superior opening of bS 

position in thorax 119 

Electricity, abnormal effects 40 

Epilepsy, cause of 4- 

Epistraxis, how cured 53 "^8 

treatment for 1S9 



87 



INDEX. 



Expression 99 

Emphysema, condition of chest 121 

Examination, how to proceed with 190 

Eyelids, granulations of 194 

cause of 194 

Eczema, treatment of 201 

F 

Face 3 99 

a disease indicator 99 

Facia, superficial circulation to 8 

center for 9 

Fever, importance of sympathetic 9 

treatment for 135-191 

treat vagus ... 192 

by poisons, treatment ..203 

Flux, treatment for 197 

case cured 197 

Fomenations 39 

Fonticulas Gutheris 91 

to reach phrenic 91 

Fontanell, anterior 98 

significance 98 

Fallopian tube, crowded by obesity ijl 

Feet, to treat 186 

cold 42 

cramp, to treat . 186 

Fainting, treatment for 189 

from overheating 193 

G 

Ganglion, superior cervical 6-8 77-92 

middle cervical 6 77-92 

1-2-3 4 connection 7 

superior cervical connection 24 25 

inferior cervical 77 92 

first thoracic 77 

Meckel's, to treat; 83 

cervical sympathetic 92 

cilliary ... 102 

connection with splanchnic. . .115 

Gasserian 103 

semi-lunar 115 

stellate 132 

inferior mesenteric, to reach, 168 

Gastritis, soreness found 22 

Giddiness, cause of 30 

Genital, trouble 35-162 

stimulation, effect eye 105 

external, nerves 161 

internal, nerves 162 

initation, reflex (case by Hilton)i63 

internal, center for 177 

Glosso-pharangeal, exit from skull 69 

fibers to parotid 108 



Goitre, exophthalmus 80 

to treat 84 180 

Glands, lymphatic 69-84-139 

membrane - 100106 

submaxillary 107 

parotid 108 

prostate, secretory fibers 142 

thyroid, enlarged in goitre 191 

parotid enlarged, to treat 191 

submaxillar}^ enlarged, to treat. .191 
sublingual, enlarged, to treat. . .191 
meibomian, cause granulated lid 194 

Gall stones, treat spleen 149 

to remove 153 

formation 161 

Gall bladder, location of 152 

work upon 160 

Gall duct, location of 160 

catarrh of 161 

Grip, to treat 189 

Granulated eyelids, treatment of 194 

cause of 194 

H 

Heart, neuralgia of, treatment for 199 

action of, to slow 202 

flutter 6 

centers 7 130 

rhythm of 8 

upper level of 10 

trouble, cause 15 

trouble caused by ribs 77 

to treat nerves 90-146 

enlarged by cigarettes 120 

outline on chest wall 122 

valves, location of i23 

nerve connection i3o 

displaced ribs, effect i30 

examination of i32 

irregular beat i33-i96 

Heart, percussion of 134 

auscultation of 134 

treatment of 145-146 

irregularity from stomach 147 

Headache 55 

uterine, cause 26 

treat 87 93 

from prolapsus i ii7 

Holden 4 

Head, vaso-motors 7 

vaso-constrictors 8 

cold in, how to treat 118 



INDEX. 



88 



Head 98 

tumors of 98 

Hip, dislocation of, case 20-5i 

dislocations of 187 

Hyperaesthesia, cause of 2I 

to treat for 61 

Hart's theory 57 

criticised 57 58 

Hyperemia, of cord 58 

how produced 60 

caused by nerves 74 

Hyoid, bone 68 

muscles causing 68 

Hiccough, to treat for .70-75-88 

Hydrocephalus 98-99 

Hay Fever, cause of 135-199 

treatment of 199 

Hysteria 171 

Hemorrhoids, cause of 151 

Hernia, inguinal 164 

femoral 164 

Hip joint, disease, to examine for 164 

Hemorrhage, postpartum, treatment for 182 

I 

Intercostal spaces 4 131 

lUium, crest of 4 10 

Iris, centers for 7 

reflex to obtain , 100 

sphincter 102-103 

dilator fibers, origin 103 104 

constrictor center 104 

Intestine, troubles, cause ,15 

contracted 63 

vaso motor 148 

ganglia 150 

large, location of 167 

small, location of 154 

stimulation of sympathetic. . .165 
stimulation of pneumogastric.165 

cramps in 166 

biliary action 166 

parasites of 2o8 

Injuries, cause of trouble 17 

Inflammation 71-72 

to treat 39 

Inhibition 38-43 

effect 85 87 88 

Inspection of chest 126 

of abdomen 155 

Innominates, displacement of 171-172 

treatment of displace- 
ments 172-173 



Influenza, to treat 189 

Insomnie, how to treat 2o2 

Inhibition .31-4.3 

J 

Jugular vein 68 

jugular foramen 69 

Jaw, muscles to stretch 83 

dislocation causing loo-lo4 

in eye trouble , . . . . 104 

spasm to feed 109 

K 

Kidneys, 1-3 4 5 

reached. 4 

pelvis of 10 

location of 11-153 

trouble, cause 15 169 

vaso-motor 148-169 

peritoneal center 148 169 

indications of disease 169 

treatment of the kidneys 169 

Bright's disease of 198 

excessive action of 198 

L 

Liver, 3 10 

location of 152 

enlarged 152 

enormous weight 152 

cirrhosis, caput medusae ...156 

con.sideration of 159 

tender in diarrhea 160 

nerve supply 160 

blood supply 160 

peritoneal center 160 

center for 6 

cirrhosis, cause 71 

treatment of 120- loo 

pain under scapula 131 

position Ml 

vaso-motor supply US 

Lumbar nerves, origin of 4 

Landmarks along spine 4 1o 

scapular 27 

concerning neck 68 75 

concerning head 98 lo5 

concerning eye loS 

concerning thorax 1 19-122 

concerning abdomen 143 

pelvis 163 

Ligamentum nuchae 4-5-48 

in headache 48 

to treat 4S 



89 



INDEX. 



Lesion?, caused bj ligiments 5-8 

caused by vertebra. 8 

caused by sprain .... 8 

caused by draft 8 

often found 15 

a<^ects what 17-18 

upper cervical 18-19 

of rib causing 24 

remove result , . . 5o 

in brain cause contracture 65 

as a contracture 06 

as bad blood 72 

significant in neck 77 

by pressure 80 81 

remove gradually 89 

at fith lumbar, cause of genital 

trouble 162 

at 2nd lumbar, cause of genital 

trouble 162 

Lung, center to 6-34-110130 

vaso-motors to 7 8 

lower lobe location lo 

part most liable to disease H 

trouble cause 1 '^- 24-77 

case treated 34 35 

apex position 75 

outline on chest 123 

nerve connections 13o 

vessels dilated 132 

vessels constricted 132 

percussion of 134 

congestion to treat 1 35 

gasses formd 135 

treatment 145 

Larynx, vaso motors to 8 

percussion over 135 

Ligament, thickening, cause 13 

condition in slipped vertebra. . 36 

stretching 49 

contracted broad, of uterus. ... 181 

round, of uterus 181 

Y shaped of hip 187 

Laryngotomy 68 

L5 mpathetic glands, enlarged 09 

^ to treet 84 

consideration of . ... 138 

nerves of 139 

Lips, indicate lo9 

Linae, masalis indicative erf disease llo 

labialis of disease llo 

alba 143 

semilunaris 143 

transversae 143 



Lymphatic duct, stoppage of 139 

Lymph, flow influenced 139 

Leucorrhea, '. . I80 

Legs, treat 1 85 

La grippe, to treat 189 

Lumbago, treatment for 2oo 

Locomotor Ataxia, to treat 2o2 

M 

Median furrow 4 

Median line 68 

Motion, center 7 

loss of 42 

Muscles, spinal congested 8-13 

primary 8 66 

secondary 8 66 

tension in 13 

Trapezius outlined 27 

to treat 28-35 36 

Deltoid pain 3o 

contracted, result , 31-34-57 

about coccyx to relax 54 

on right contracted 58 

on left contracted -8 

scapular, to stretch 62 

Scaleni, to stretch 62 

psoas, how to reach 62 

caution 62 

tonus 64-67 

welt 65 

flabby 67 

of throat ..69 83 

hyoid cause of trouble 69 

Stern o- mastoid 75 92 

omohyoid 75 

quadratus lumborum to stretch. . . 75 

scaleni significance 76 

scaleni to stretch 93 

pyriformis in sciatica 87 93 

pectoralis major 119 

serratus magnus 119 

erector spinac II9 

psoas magnus 120 

deltoid 121 

quadratus lumborum 75-137-174 

coccygens 164 181 

gluttei 164 

deltoid fibers caught 185 

biceps contracted 185 

quadriceps extensor, to stretch. . 185 

of thigh, to relax 186 

Measles, with whooping congh 139 

treatment of 2o2 

Mammae, treatment of 144 



INDEX. 



90 



Micturition, frequent, in prolapsus 178 

Milk leg, cause 189 

Menstruation, profuse, treatment for. . . . 182 

Meningetis, treatment of 2oo 

cau5e of 2oo 

Mouth, nurses sore mouth 189 

fore mouth in mother 189 

sore mouth, treatment for 189 

N 

Neurasthenia 47 

cause 74 

Neck, to manipulate 6 82-91-92 

to examine 68-75 76 

to reach other organs 68 

care in stretching 199 

Nutrition, center 7 

Neuralgia, intercostal, cause 24 

lumbar 25 

5th group of nerves. 25 

case of 5th nerve 89 

of heart 199 

treatment 2ol 

Nose bleed, how stopped 53 

Nerves, phrenic origin of 6 

vaso motor 6 

splanchnics , 6-7 

upper aurical, 1st group 18 

lower aurical, 2d group 24 

cervical connection 24 

12 dorsal Sd group 24 

5 lumbar 4th group 24 

lumbar diseases 25 

o sacral 5th group, dieases of 25 

dorsal 6 and 7, cause of trouble 21-25 

all reached by O 43 

acceleration fibers 131 

Nerve, force misdirected 13-14 

centers ; . . .7 8-9 

roots, emergence of 21 

5lh, how reached 22-99 

impulses reorganized 26 

force inhibited 34-41 

force stimulated 34-41 

force effected 38-39 44-52 54-60 

section result 43-44 

action effected in three ways 54 

trophic connection 68 

9th exit 69 

10th exit 69 

11th exit 69 

Nerve, phrenic 69 94-95 135 

sub-occipital 77-91 

ulnar effected by rib 79 



Nerves, pressure upon 79-80 81-82 

sheath in degeneration 81 

of heart to treat 9o 

terminals to reach 99 

third 102 

fifth 103 

of wrisberg 103 

optic to shock 105 

facial exit . 

auditory, to inhibit 112 

viscero dilators 116 

" constrictors 116 

pulmonary vaso-constrictors 13 [ 

sciatic, stimulation of 132 

pueumogastric 135 

connections 14I 

sacral distribution I42 

sup-laryngeal irritated I45 

sciatic to reach 164 

pudic to locate I64 

'* to infringe upon 174 

anterior crural 186 

sciatic to stretch I87 

Nose, to examine 112 

fractures 112 

growths in 112 

deflection of 112 

to clear out 112 

to treat 112 

bleed, to check 1S9 

Nervous prostration, treatment of 194 

Nipple, location of 119 

stimulation of, in abortion 182 

Nausea, between 4th and 5th ribs 159 

Nurse's sore mouth ]89 

Ovary, blood supply to 7 

location 176 

treatment 170 

center for blood supply 177 

seat of tumor 178 

Obesity, treatment for 139 

crowding ovary 177 

Osteopathic reasoning.'. .18 14- 15-10 17 21 ol 

in paralysis 22 

in gastritis 23 

how we get results 31 

physiological 31-32 

diagnosis 24-50 

adaptability 51 

work through N. terminals 67 

points on the eye 101 

Occiput 99 

Phrenic nerve 75 



91 



INDEX. 



Phrenic nerve 75 

origin 6 

trouble in . . T = . 19 

pressure causes 32 

to treat 91-94 

connections , 94 

Pyloric orifice, v,enter for 6 

Pneumogastric nerve, treat in fever 192 

Left .' ....6 

connection with 5th nerve 86 

sympathy in dist. of 5th and 10th. .53 

exit from skull 69 

to treat 69 

location 76 

treatment of 86 

Stimulation of . 1 32 

Plexus, anterior pulmonary 7 

posterior ' * 7 

hypogastric , 7-8-162 

to intestinal canal 8 

to bladder 8 

to vas def erentia 8 

great prevertebral 90 

primary 9 

secondary 9 

importance of 9 

brochial. 24-77 

cervical 77 

Merisners 80-147 

renal 115 

solar, in headache 117 

solar 50 

solar, pressure condenses gas 159 

solar connection of 14^ 

sacral 8 

Billroth's 147 

Auerbach's, location of 149 

meissner, locati on of 149 

hepatic 150 

Pelvic, brain. 7 

trouble, cause 35 

aortic 130 

cardiac , 130 

viscera ... 35 

viscera, how to treat 178 

Phonation, center 7 

Pelvis, consolidations 143 

how to treat 171 

pylorus 10 

Paralysis, crutch 19 135 

caused by grippe. . , _, 178 

cause >...... .■ 22 

Pleura, trouble cause 24 



Pharynx, protrusion in dislocation 47 

Pancreas, location of 10-153 

Pott's disease 73 

Physiognomy 109 

Prolapsus 117 

Prostate gland,] secretory fibers 142 

enlarged 175-183 

to reduce 183-183 

Pain, cause in face and head 19 

diagnosis by 21-25 

treat to cause 86 

in knee, in hip trouble 97 

in heart trouble 131 

under scapula 131 

in stomach on pressure 157 

in lumbar region 173 

in the hip 173 

in the leg 173 

in the sacral region 173 

Parturation, hip dislocation in 189 

Peritonitis, cause 81 

condition of 162 

Palpation of chest 125 

Percussion of chest 126 

of heart 133 

Pneumonia, treatment of 195 

Parasite, intestinal, to treat 203 

Pulse, always note 133 

Pregnancy, simulated by gas 179 

Pneumogastric, cause of asthma 135 

Piles, cause of 151 

Perineum, boundary. ... 164 

shape of 164 

to cause contraction of 164 

Q 

Quotations, Emerson 3 

Huxley 3 

Holden 8-27-67-75 

Ouain 9 72-73 77-101-103-118 131 

Hilton 17-21-25 

Halliburton i6 

Hilton, ear nerves to 18 79 96 97 

cervical disease 19 

Hildreth, treatment and diagnosis 21-51 

contractions of spinal m 58 59 

Byron Robinson 78-81-105-115 

Abdominal brain 26 80 

sympathies 60 

Dr. Eastman 27 

Dr. Lombard 38 

physiology 33 

Dr. W. T. Porter, M. D., physiology 33 

Dana, applied eh.'ctricity 33 



INDEX, 



92 



Dr. Eckley, sciatica 33 

Dr. McConnell 38 

correct lesion* 52 

Dr. Harry 38 

Dr. C. M. T. Hulett 38 52 

Howell's Text-Book 40-44-61-64-G5-118 

renal constriction 39 

nerve irritability. 40 

Kirk Physiology 45 

vaso-motors leave cord 59 

muscle tonus 64 

Green's Patholoojy 39-44 71 72 80 

Dr . Jacobson 96 

reflex sensation 53 

case of child, bean in its ear 53 

Lawrence Hart, theory 56 

criticised 57-58 

Gower's nervous system 59-64 65 66 

flabby muscle 67 

Dr. Allen 63 

contracture definition 64 

Billroth, cause of contracture 66 

Gaskell by Quain 115 

Flint on splanchnics 115 

R 

Rib, last 4 

1st may cause 6 

lesions in causing 24 

1st and 2d preparatory to setting. . .62 

1st and 2d may cause 76-77 

displacement of 1st and 2d 128 

1st and 2d to set 1 36-137 

rules to count 119 

location of 1 19 

sternal ends of 120 

dispaced to examine for 127 

tenderness along 127 

twisted 127 

cartilage displaced from 128 

3d and 6th displaced 130 

to raise 136 

Renal, center 7 

artery 10 

trouble, cau.se 15 

splanchnic to treat 120 

colic, treatment of 170 

Respiration center 7 

Retina, affected by sup. cei v. ganglion. . . .8 
vaso motors 104 

Rami, communicantes 9 10 1 i5 

origin t) 

distribution H» 

nerves to genital orgar.s 161 



Receptaculum chyli, location of 10 

controlled by splanchnics 139 

Rheumatism, to absorb deposits 52 

articular, to treat I84 

treatment of 196 

muscular, to treat 196 

Reflex action 53 

knee, to get 59 

Regions, supra clavicular 124 

clavicular. 124 

infra clavicular 124 

mammary 1 24 

sternal 124 

supra sternal 124 

inferior sternal 124 

superior sternal 124 

supra scapular 124 

scapular 124 

infra scapular 124 

inter scapular 124 

epigastric 152 

umbilical 152 

hypoga trie 152 

of back 173 

lumbar 1 73 

sacral 175 

Rectum, nerves supply 142 

examination 182 183 

prolapsed 1 83 

s 

Sore spots 3-5 22 28-34 35-59-77-178 

to what due 23 

success 3 

basis of 6 

Spine, to treat 27 28-34 41 45 04-61 

general consideration tf 8 

landmarks 4 10 

Spinal nerves, origin 3 

Suiface.of body, follows upon 4 

Scapular spine 4 

inf. angl ? 4 

Scapula, l(>caiion 27 

Space, iutercostal 4 

illiocostal 4 

sub-clavicular 1 22 

2iid intercostal 122 

axillary 1-4 

infra Hxillary 1 24 

popliteal ISti 

8d left intercostal to protluce voni .201 

Sympathetic, centers 6 

t«up cervical ganglion ()-24 2,") 

swslem 5> 



93 



INDEX, 



Sympathetic, connection to C. S 9-22 

distribution centrally 9 

peripherally 9 

secretory fibers 9 

pilo-motor fibers 9 

significance of 9 

to affect distribution of 28 

stimulation in neck 132 

Spine, illustrations upon. . . 5 

examination of 5-8 11-12-27 

smooth 5,14-45-48 

cause of 45-46 

condition on examination 8 

noises along 12-16-18-27-36-37-61 

curves, abnormal 15-16-54 

" results 15 

to sit 37-54 

disease of, origin 16 

'* to diagnose by pain. .. . 21 

Stomach, center 6 

cardiac orifice opposite 10-153 

interference with center 13 

trouble, cause 15-35 

" causing welts 66 

' ' exercises in 97 

location 144 

nerve supply 147 

changes position 152 

. pain on pressure 157 

to free of its contents 159 

sick, reflex 159 

Splanchnic nerves, great 6-114 130 

small 7 115-120 

smallest 7-115 

equalize circulation 61-117 

much treated 114 

pelvic 115 

connections 115 

connections with medulla 116 

to affect viscera 117 

renal to treat 120 

Sphincter, ani center for 7 

" contraction, cause 14 

relaxation of 14 

rectal dilatation...: 132 

of bladder 142 

of blodder, to relax and 

contract 175 

Spasm, center for 7 

5th group of nerves 25 

Salivation, center. 7 

Sneeze 7 

Se n Si- 1 ion, center 7 

loss of 42 



Salivary gland, to affect 8 

sup. cervical ganglion, connections. .8 

Sciatica 8 15-40 

vaso-motor 32 

cause 87-141 

treatment for ; 187 

Synchondrosis, sacro illiac 164 

Sweat glands, nerves to 9 

Spines, parts opposite 10 

separated, cause of 14 

' ' result 14 

twisted, " 14 

separated, to treat 41 

approximated to treat 45 

posterior to treat 47 

Spleen, upper margin of 10 

vaso-motors of 148 

congested. 149 

location -.153 

enlarged 157 

treat for gall stones 161 

treatment of 168 200 

Supra renal capsules 10 

Stimulation 38 41-43 

effect 85-87 

Spinal cord, termination of 10 

Scleiosis of 71 

Scar tissue 71-72 

cause of trouble 71 

Sacrum, abnormal 11 

ant. or post 55 

to set 55 

Spinal, accessory nerve 68 

Sinus, frontal G9 

Sternum 119 

2nd rib with 119 

end of 120 

Shoulder, dislocation i 184 

deltoid fibers caught 185 

Saphenous, opening 188 

vein to treat 189 

Strabismus, treatment of. . 194 

Sprain, treatment ot 197 

Seasickness, to treat 202 

T 

Theory 3 

osteopathic 31 

to effect internal viscera 31 

work on centers . . 43-50 53-56 63-7o 78 

of stretching ligaments 49 

Hart's . 56 

of fever 192 



INDEX. 



94 



Trapez,.!.-. muscle "^ 

outlined . . , ^'7 

Tongue, to affect 8 

vaso dilator 1^^ 

vaso constrictor 107 

to examine 109 

depressor 109 

furred on one side 113 

Trachea, bifurcatonof . 10-119 

Treat, of spine. . . .27-28-34,41 45-46-47 54-61 

of centers 27 

of neck 46-82-9192 

time taken 35 

of inflammation 39 

between shoulders 46 

straddle 61 

too frequent 89 

of eye ...102-106 

of ear 112 

of nose 112 

of throat 113 

of cartilages 137 

to raise ribs 137 

Toothache, to treat 203 

Thyroid, cartilage 68 

thyroid gland 68-69-191 

Throat 69 

to treat 82-113 

to examine lo9 

Tonsil 69 

location lo9 

size , 109 

Temperature, changes on surface 79 

of neck 77 

Tumor 80 

abdominal 140 

Tympanum, appearance 110 

appearance if inflamed Ill 

Thorax, landmarks of 119 

sup. operature of 119 

to examine 119-123-124 

treatment of 120 

succussion of, 144 

Tuberculosis, signs of 125 

Thoracic duct, obstruction of 139 

Typhoid fever, treatment of bowels 151 

Triangle, scarpa 186 

u 

Uterus, flexion ' 178 

displaced, cause of headache 178 

examination per vaginum 179 

ligaments 179 

methods of replacing 180 



Uterus, blood supply 181 

round ligament 181 

broad ligament 181 

prolapsus of child 181 

treatment in child 180 

examine per rectum 182 

center for cervix 7 

center. . 7 

nerves to 7 

prolapsed causing 117 

congested relieved 118 

motor fibers 140 

center for blood supply 162 

prolapse 176 178-180 

to raise 176 

version 178 

Uterine tumor, causing 26 50 

trouble, cause and causing .27 

displacem't, sympathetic troubles 178 

souffle in pregnancy 178 

cervix 179 

Umbilicus, location of 10 143 

Urula .113 

Urine, retention of 176 

increased, by reading, in hysteria. 

Urethra, twist in 182 

stricture of 183 

V 

Vertebra, to line up 4 

dorsal spines 4 

peculiar 5 

' ' caution 15 

11 and 12 dorsal to set 41 

1st and 3d cause eye trouble 104 

4th and 5th dorsal, eye trouble. . . . i05 

Vaio-motor nerve s 6 

to arm. 6 

to lungs 7-S 

jejunum 8 

to small intestine S 

to large * ' 8 

intestine M^"^ 

for bowels. 8 

to sciatic 31 

center 7 

circulation 8 

effect by cold . . , o9 

for liver 8 

for kidnej' s 8-14S 

for splf en 8 

for lower limbs 8 

for vulves of heart 8 

for larynx 8 

of rabbit's ear •♦ V44 



95 



liNDKX. 



Vagina, centei lO relax 7 

examine by rectum 182 

Vomit, center 7 

to cause 200 

treatment 200-201 

Vaso, constrictor for head 8-90-91 

dilators, origin 10-59-90 91 

constrictors 10-59-60 

Vein, ext. jugular corresponds 68 

* ' " pulsation 68 

location 75 

facial location 105 



Vein, innominate 75 II9 

abdominal dilated . 117 

saphenous, treat after parturition . . 189 

obstruction of, in goitre. . . 192 

varicose, treatment of 199 

w 

Water, hot 39 

cold 39 

Wallerian degeneration 81 

Worms, to destroy. , 168 

treatment for 202 

Whooping cough, measles with 139 



The following index with reference to the'particular vertebrae and ribs is 
added to assist not only in diagnosis but in the treatment of any abnormal 
conditions found. For example : Should one have a case with a lesion of the 
4th dorsal, by consulting the index under that vertebra he would at once be 
referred to all that has been said in the text as to effects of such a lesion. The 
same can be said of any one of the vertebrae. In other words, should he not 
find what he wanted in the regular index this special index would be useful. 

1st Cervical. cervical brain 7 

Atlas 5 7 rhythm of heart 8 

cervical brain 7 5th Cervical. 



sensation 7 

larynx. 8 

articulation of 26 

effect the ear 99 

" eye 99 

dislocation of 104 

ear troubles iii 

effect the kidney 169 



phrenic, origin 6 

cervical brain 7 

cilio spinal center 7 

ankylosis. 17 

level of cricoid cartilage and oesopagus ...-68 

6th Cervical. 

origin of nerves 3 

prominence of 4 



2d Cervical. .^j, . , ,. 

sup. cervieal ganglion 6 "^'^^^^ ^^^^^^^^ ganglion 6 

cervical brain 7 ^^^^^^^ ^'"^^^ 7 

center for uterus 7 ^^^osis 17 

larvnx 8 level of cricoid caitilage and esophagus.. ..68 



articulation of 26 

Sd Cervical. 

middle of neck 6 

sup. cervical ganglion 6 

phrenic, origin 6 

cervical brain 7 

rhjrthm of heart 8 

larynx _ 8 

dislocation of 104 

inhibit auditory nerye it2 

in hay fever 185 

^-oh Cervical. 
phrenic, origin 6 



7th Cervical- 

prominence 4 

middle cervical ganglion 6 

ant. branches to pulmonary 7 

cervical brain 7 

apex of lung 10 

pecuiar vertebra 13 

ankylosis 17 

transverse process 75 

1st Dorsal. 

center to lungs. 6 

ant. branches to pulmonary 7 

cervical brain 7 



INDKX. 



9b 



abdominal brain 7 

heart center 7 

jejunum 8 

importance of. l5 

haemiplegia i6 

lateral dislocation, to set 203 

2d Dorsal. 

center to lungs 6 8-116 

ciliary center 6 

ant. pulmonary branches 7 

cervical brain 7 

abdominal brain 7 

vaso-motor center 7 

cilio spinal center 7 

heart center 7 

lower limbs 8 

circulation to superficial fascia 8-9 

valves of heart 8 

renal trouble 15 

sciatica 15 

lesion 34 

sup. cervical ganglion 77 

upper aperature of thorax 119 

lateral displacements to set 203 

3d Dorsal. 

corresponds 4 

ciliary center 6 

ant. branches to pulmonary 7 

cervical brain 7 

abdominal brain 7 

heart center 7 

aorta 10 

lung 10 

trachae 10 

sup. cervical ganglion, location of 77 

sound of aorta is heard 1 24 

Jfth Dorsal. 

origin of nerves 3 

center for stomach 6 

' ' pyloric orifice 6 

ant branches to pulmonary 7 

cervical brain 7 

abdomiual brain 7 

sensation 7 

motion 7 

cilio spinal center 7 

heart center 7 

valves of heart 8 

aorta 10 

heart 10 

trachea bifurcation 11 



nutrition center 139 

5th Dorsal. 

center for stomach 6 

' ' pyloric orifice 6 

vaso-motors to arm 6 

splanchnics 6 

ant. branches to pulmonary 7 

abdominal brain 7 

heart center 7 

vaso- constrictors 8 

jejunum 8 

circulation of superficial fascia 9 

in hay fever 185 

6th Dorsal. 

vaso-motors to arm ^ . . 6 

splanchnics 6 

ant. branches to pulmonary 7 

abdominal brain 7 

nutrition 7 

vaso-motor centers 7 

vaso constrictor 8 

kidneys 8 

lesion 13 

corresponds 120 

7th Dorsal. 

corresponds 4 

splanchnics 6 

ant. branches to pulmonary 7 

abdominal brain 7 

center for lungs 8-1 16 

lesion 13-34 

location of mid . cerv, ganglion 77 

inf. «' " 77 

finding space 124 

8th Dorsal. 

splanchnics 6 

center for chills 6 

' * liver 6 

ant. branches to pulmonary 7 

abdominal brain 7 

spleen 8 

heart 10 

diaphragm central tendon 10 

stomach trouble 13 

spleen, to treat 200 

9th Dorsal. 

center for liver 6 

splanchnic, small 7 

ant. branches to pulmonary 7 

abdominal brain 7 



^1 



INDEX 



cervix uteri 7 

peristalsis of bowels 8 

spleen, upper erlge lo 

oesophagus lo 

vena cavae lo 

sound of aota is heard 1 24 

avoid in pregnancy 181 

lOtU Dorsal. 

splanchnic, small 7 

abdominal brain 7 

pelvic brain 7 

peristalsis of" "bowels .... 8 

lung, lower edge 10 

liver 10 

stomach cardiac orifice 10 

corresponds T2o 

in female trouble. 162 

center for ovary 177 

11th Dorsal- 

origin of nerves 3-4 

splanchnics, small 6 

abdomi nal brain .7 

blood supply to ovaries 7 

peristalsis of bowels 8 

spleen, lower edge 10 

supra renal capsule 10 

kidney, location 11 

in female trouble I62 

center for ovary 177 

avoid in pregnancy 181 

12th Dorsal. 

origin of nerves 4 

corresponds 4 

methods to ascertain position of 4 

splanchnic, smallest 7 

abdominal brain - 7 

pleura, lowest part 10 

aorta 10 

pylorus TO 

kidney 11 

separation liable 13-41 

lateral displacement 35 

lumbar enlargement 61 

spleen to treat 200 

1st Rib. 

heart flutter 6-15 

heart center 7 

preparatory step to setting 62 

subclavian artery crosses 75 

attachment of scaleni muscles 77 

location of infra cervical ganglion 77 



exostosis of 79 

reach the vagus 94 

found 119 

displaced upward 128 

cause trouble with heart 132-146 

in b. ^uchitis 135 

to set 136 

lymphatic obstruction 139 

in lung trouble 146 

'2(1 Rib. 

heart trouble 15 

preparatory step to setting 62 

attachment of scaleni muscle 76 

found ,... 119 

edges of lung 123 

bounding spaces 124 

displaced upward 128 

cause of heart trouble I3c?-i46 

trouble with in asthma 135 

in bronchitis, to set I35-136 

in lang trouble 146 

3d Rib. 

bounding spaces 124 

displaced 130 119 

in bronchitis 135 

4th Rib. 

fourth iig-]23 

displaced 130 

nausea 158-159 

5th Rib. 

displaced 130 

in lung trouble 146 

nausea . 159 

6th Rib. 

sixth corresponds 1:9-122 123 

bounding spaces 124 

trouble with in asthma 135 

7th Rib- 

seventh rib 122 

cause of asthma 15-135 

corresponds ... 119 

space boundary 124 

linea semilunaris 143 

cardiac orifice of stomach 153 

8th Rib. 

eighth corresponds 119 

pyloric orifice of stomach 153 

9th Rib. 

spleen for gall stones 149 153 -161 

gall bladder 152-16O 



INDEX, 



98 



displaced in gas distension 159 

raise gently in typhoid . . (Part 11) 24 

10th Rib- 

lower limit lung 123 

cartilage displaced 128 

spleen for gall stones 149-153 16 r 

boundary of abdomi ial regions 152 

location of spine 152 

raise gently in typhoid . . ( Part II) 24 

1 Uh Rib. 

eleventh : ... T19 

down 128-129 

spleen for gall stones I49 153-161 

dianhea 166-167 

flux, to treat 197 

raise gently in typhoid . . (Part II) 24 

hold at the head of in typhoid 24 

12th Rib. 

head of last lib 4 

drawn down . .. 76 128 129 

twelfth 1 1 9 

bounding space I24 

diarrhea 166 i67 

flux, to treat 197 

First Lumbar. 

origin of nerves. 4 

abdominal brain 7 

small intestine 8 

large intestine 8 

renal artery 10 

kidney pelvis of 10 

separation of 4 r 

lumbar enlargement 6r 

boundary regions of abdomen. 152 

Secoixd Lumbar. 

center for parturition 7 

micturition 7 

defecation 7 

abdobinal brain 7 

uterus, 7 

kidneys 8 

spinal cord 10 

pancreas 10 

duodenum 1 ci 

receplaculum chyli 10 

boundary of abdominal region i52 

spleen 153 

effect on bladder 1 73 

center for internal genitals 177 

avoid in pregnancy 181 



Third Lujubar. 

corliac axis 7 

abdominal brain 7 

umbilicus 10 

kidney, lower border 10- 11 

Fourth Lumbar. 

corresponds 4 

center defecation 7 

large intestine 8 

genito-spinal center , 8 

lower hypogastric plexus 8 

plexus to ini estinal canal . . . , 8 

bladder and vase deferentia 8 

aorta lO 

illium, highest part 10 

Jtifih Lumbar. 

center defecation. 7 

center for hypogastric plexus 7 

pelvic brain 7 

va.so motor center 7 

circulation to fascia 8 

genito-spinal center 8 

lower hypogastric plexus 8 

phxus to intestinal caral ..8 

bladder and vaso deft rentia 8 

separation liable 13 

lameness 76 

nerve .supply to fundus of bladder i75 

effect on bladder 175 

center for internal genitals 177 

avoid in pregnancy 1 8 [ 

treat for la grippe 189 

Sacrum. 

center for bladder (neck ) 7 

center to vulva and vagina 7 

center to sphincter ani 7 

lesion 13 

atiterior and posterior 55 

lameness ~K\ 

fifth sacral in constipation 49 

Coci'lix. 

nutiition 3 

canst of piles 11 17 

dii«L^cftied 34 

cause of di.inhea i(->7 

Clavicle. 

to reach vrigus Q4 

to set, . . \2 \ 






Ankylosis, caused by diseased discs 4 

B 

Barber's itch 80-81 

bowels, keep open 81-83 

c 

Cares of veitebra 3-4 

Cold feet 82-83 

Chilly feeling 83 

Curvatures, (see spine). 

Colic 81 

Convulsions 81 

Cephalodynia 36 

Catarrh 39 

description of 41 

symptoms of 41-42 

cause of 41-42 

secretions in 42 

treatment 40-44 

2d or 3d cervical deviated 44 

Colds 42 

etiology 42 

symptoms 42 

complications 43 

treatment 43 

particular method of 45 

Croup 45 

membranous, treatment of • • • 45 

Constipation 46 

definition by Quain 46 

symptoms 47 

etiology 47 

local causes 48 

osteopathic theory of 48 

treatment 50 

(a) splanchnic 50 

(b) over abdomen ...51 

(c) in neck 52 

(d) local 52 

(e) adjuvant 52 

Catarrh of intestines 54 

D 

Disease of vertebra 3 

of intervertebral discs 3 

Pott's, etiology of 4-5 

Diet, in typhoid fever 22 



Dorsodynia 36 

Diarrhea, success in treating 54 

etiology 54 

causes 55 

osteopathic theory 55 

treatment of 58-59 

Dysentery, consideration of 54*56 

etiology 56 

pathology 56 

symptoms 57 

osteopathic theory 57 

treatment 59 

Drugs, division of 60 

E 

Exercise an aid 16 

Effleurage 76 

Eczema 81 

F 

Fever, typhoid 18 

etiology 18 25 

stages 19 

symptoms 20 

temperature in 20 

perforation in 21 

hemorrhage in 21 

diet in 22 

treatment in 23-24-28-80-83 

malaria 25 

germ 26 

pathology 26 

symptomatology . . 26 

quotidian .27 

tertian .... 27 

quartan 27 

Fish poisoning 8 r 

Feet, cold 82-83 

G 

General treatment , 82 

H 

Hemorrhage, from bowels, treatment for. 24 

History of medicine, definition of 59 

Heart's action, slowed 81 82 

I 

Intervertebral discs, disease of 3 

alteration in shape and size 4 

destruction of 4 



lOI 



INDEX. 



Rheumatism, muscular, lumbago. 36 

cepholodyuia 36 

dorsodynia 36 

pleurodynia. 36 

treatment 36-37 

Rubbing 77 

s 

Spinal curvatures 3-4 

success in treating. 3 

importance of 3 

ligament, disease of 3 

muscle, disease of 3 

blood vessels, interference with 3 

nerves, " " 3 

treatment 4 

Spinal curvatures, Pott's disease 4 

scblerosis 4-7 

Kyphosis 't-ii 

lardosis 4 11 

Spastic 4 

hysterical 4 

compensation 8 

etiology of 8 

anatomical characteristics 9 

pathology of 9 

symptoms of 10 

in whom found 11 

treatment of 12 

surgically of 13 

exercise an aid 16 

Swedish movement 76 

Stroking 76-78 

Spit en, treatment' of 80 

Stools in typhoid 19 

Spleen, congested in malaria 28 

Solar piexus in constipation 51 

Spine to spring 15 

rigid, troubles caused by 4 

smooth, " " " 4 

treatment of 4 

tuberculosis of 4 



Tuberculosis of spine 4 

Treatment : 

catarrh 40 44 

colds 43-45 

constipation 50 52 

diarrhea 58-59 

dysentery 59 

fevers 2t; 24-28-30-83 

influenza 43 

lumbago 36 

la grippe 43 

malaria 25 

manual y6 

Potts' disease 416 

poisoning . 81-83 

rheumatism 36-37 

spinal curvatures. 4-16 

spine 4 

special and general 82 

toothache 83 

vomiting 80 

worms 82 

Theory of work in curvatures 15 

Typhoid fever 18 

etiology iS 

stages in 19 

symptoms 20 

temperature 20 

perforation in 21 

hemorrhage in 21 

diet in , 22 

treatment in 23 

Tapotement -5 

Tapping 76 

V 

Vomiting So 

w 



Worms . 



INDEX. 



lOO 



Influenza 39 

varieties 39-40 

clinical features 4o 

symptoms of 
f I. catarrhal type 4o 



thoracic 



3. gasiro-intestinal 



4o 
40 



[4. cerebral type 41 

sequelae 4i 

etiology .41 

treatment 43 

Insomania 82 

K 

Kyphosis 1 1 

pathology of , 1 1 

Kneading 76 

L 

Ligaments of vertebra, disease of 3 

blood and nerve supply 15 

Locomotor ataxia 82 

Lardosis 11 

Lumbago 35 

case < f 38 

lesion 38 

La Grippe 39 

varieties 39-40 

clinical features 40 

symptoms of 

f I. catarrhal type 4o 

J 2. thoracic " 40 

j 3. gastrointestinal 40 

[4. cerebral t\pe 41 

sequelae 41 

etiology .... 41 

treatment 43 

cerebral treatment 43 

liver treat in constipation 51 

M 

Myelitis 5 

Malaiia, consideration of 25 

etiology 25 

the germ 26 

pathology 26 

symptomatology 26 

quotidian 27 

tertian 27 

quartan 27 

treatment 28 

M assage 76 

Manual treatment 76 

Meningitis 80 

Myocarditis, caused by rheumatism 3i 



H 23 



Medicine, history of 61 

Roman 64 

Arabian 66 

scholastic period ... 67 

in the' 17th century 70 

circulation of the blood discovered . 7O 

N 

Nechrosis of vertebra 3 

Neuralgia 81 

P 

Pott's disease, consideration of 4 

age in which occurs 4 

etiology of 4 

etiology, constitutional 5 

symptoms of 5 

pathology 5 

cure if early treatment 16 

Pelvis, obliquity of 8 

Parasites 83 

Pleurodynia 36 

Plexus, Auerback's ruling motion 48 

Meissner's " secretion 48 

solar in constipation 51 

Petrissage 76 

Paralysis 81 

Poisoning, treatment 81-83 

Fneumogastric, treatment of 59 

Q 

Quotations— Ouain 5-46 

Magendie -. 60 

R 

Rheumatism, facute articular 30 

chronic " 30 

muscular 30-35 

causes of 30 

rheumatic fever 30-34 

etiology 30 

pathology .- 31 

symptoms 31 

course 33 

duration 33 

termination..^ 38 

complication 33 

diagnosis 33 

prognosis 33 

etiology 35 

symptoms 35 

Rheumatic fever 34 

etiology 34 

pathology 34 

symptoms 34 

complications 35 

3 83^'^ 




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N. MANCHESTER. 
INDIANA 46962 



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